Impact of HIV-AIDS on care and outcomes of severe sepsisReportar como inadecuado




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Critical Care

, 9:R623

First Online: 27 September 2005Received: 27 May 2005Revised: 21 August 2005Accepted: 01 September 2005

Abstract

IntroductionThere has been dramatic improvement in survival for patients with HIV-AIDS; however, some studies on patients with HIV-AIDS and serious illness have reported continued low rates of intensive care. The purpose of this study was to examine patterns of care and outcomes for patients with severe sepsis and HIV-AIDS and compare them with those of patients with severe sepsis without HIV-AIDS.

MethodsWe assessed data from all 1999 discharge abstracts from all non-federal hospitals in six US states. Patient demographic characteristics, discharge diagnoses, resource use, and outcomes were extracted. Analyses were performed using chi-square, Wilcoxon rank sum, or regression techniques, as appropriate.

ResultsWe identified 74,020 patients with severe sepsis 7,638 10.3% had HIV-AIDS using ICD-9-CM codes. Patients with severe sepsis and HIV-AIDS had a similar mean length of stay 16.9 days versus 17.7 days; p = 0.0669, had lower mean hospitalization cost $24,382 versus $30,537; p < 0.0001, were less likely to be admitted to the intensive care unit 37% versus 56%; p < 0.0001, and had a greater mortality 29% versus 20%; p < 0.0001 than those without HIV-AIDS. After adjustment for cohort differences, patients with severe sepsis and HIV-AIDS had increased likelihood of death OR 95% CI = 2.41 2.23–2.61 and were substantially less likely to be admitted to the intensive care unit OR 95% CI = 0.54 0.51–0.59. When compared with those with severe sepsis and HIV-AIDS, patients with severe sepsis without HIV-AIDS were universally more likely to be admitted to the intensive care unit, even when they had comorbid illnesses with equal or worse expected in-hospital mortality e.g., metastatic cancer.

ConclusionFor patients with severe sepsis, there are differences in care and outcomes for those with HIV-AIDS. Further research is needed to examine the delivery of care for patients with severe sepsis and HIV-AIDS.

AbbreviationsCIconfidence interval

HAARThighly active antiretroviral therapy

ICD-9-CM = International Classification of Diseases9th revision, Clinical Modification

ICUintensive care unit

LOSlength of stay

ORodds ratio

SSsevere sepsis.

Electronic supplementary materialThe online version of this article doi:10.1186-cc3811 contains supplementary material, which is available to authorized users.

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Autor: Joseph M Mrus - LeeAnn Braun - Michael S Yi - Walter T Linde-Zwirble - Joseph A Johnston

Fuente: https://link.springer.com/







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