Clinical spectrum and prognostic impact of cancer in critically ill patients with HIV: a multicentre cohort study

Annals of Intensive Care

Research

Thierry Boulain¹  François Barbier¹  Piotr Szychowiak¹  Laurent Argaud²  Florent Wallet³  Élie Azoulay⁴  Alexandre Elabaddi⁵  Nahema Issa⁶  Jean-Pierre Quenot⁷  Frédéric Martino⁸  Emmanuel Canet⁹  Stephan Ehrmann^1,10  Jean-François Timsit^1,11  Fabrice Bruneel^1,12 

[1] Médecine Intensive Réanimation, Centre Hospitalier Régional d’Orléans, 14, Avenue de L’Hôpital, 45100, Orléans, France;Médecine Intensive Réanimation, Centre Hospitalier Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France;Médecine Intensive Réanimation, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Lyon, France;Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France;Médecine Intensive Réanimation, Centre Hospitalier Universitaire Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France;Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France;Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Dijon-Bourgogne, Dijon, France;Médecine Intensive Réanimation, Centre Hospitalier Universitaire de La Guadeloupe, Pointe-À-Pitre, France;Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France;Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Tours, Tours, France;Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France;Réanimation et Unité de Surveillance Continue, Centre Hospitalier de Versailles, Le Chesnay, France;

关键词: Human immunodeficiency virus;    Cancer;    Intensive care unit;    Treatment limitation decision;    Outcome;   

DOI  :  10.1186/s13613-023-01171-4

 received in 2023-06-04, accepted in 2023-08-04,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundBoth AIDS-defining and non-AIDS-defining cancers (ADC/NADC) predispose people living with HIV (PLHIV) to critical illnesses. The objective of this multicentre study was to investigate the prognostic impact of ADC and NADC in PLHIV admitted to the intensive care unit (ICU).MethodsAll PLHIV admitted over the 2015–2020 period in 12 university-affiliated ICUs in France were included in the study cohort. The effect of ADC and NADC on in-hospital mortality (primary study endpoint) was measured through logistic regression with augmented backward elimination of potential independent variables. The association between ADC/NADC and treatment limitation decision (TLD) during the ICU stay (secondary study endpoint) was analysed. One-year mortality in patients discharged alive from the index hospital admission (exploratory study endpoint) was compared between those with ADC, NADC or no cancer.ResultsAmongst the 939 included PLHIV (median age, 52 [43–59] years; combination antiretroviral therapy, 74.4%), 97 (10.3%) and 106 (11.3%) presented with an active NADC (mostly lung and intestinal neoplasms) and an active ADC (predominantly AIDS-defining non-Hodgkin lymphoma), respectively. Inaugural admissions were common. Bacterial sepsis and non-infectious neoplasm-related complications accounted for most of admissions in these subgroups. Hospital mortality was 12.4% in patients without cancer, 30.2% in ADC patients and 45.4% in NADC patients (P < 0.0001). NADC (adjusted odds ratio [aOR], 7.00; 95% confidence interval [CI], 4.07–12.05) and ADC (aOR, 3.11; 95% CI 1.76–5.51) were independently associated with in-hospital death after adjustment on severity and frailty markers. The prevalence of TLD was 8.0% in patients without cancer, 17.9% in ADC patients and 33.0% in NADC patients (P < 0.0001)—organ failures and non-neoplastic comorbidities were less often considered in patients with cancer. One-year mortality in survivors of the index hospital admission was 7.8% in patients without cancer, 17.0% in ADC patients and 33.3% in NADC patients (P < 0.0001).ConclusionsNADC and ADC are equally prevalent, stand as a leading argument for TLD, and strongly predict in-hospital death in the current population of PLHIV requiring ICU admission.

【 授权许可】

CC BY   
© La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF) 2023

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