Six-month survival of critically ill patients with HIV-related disease and tuberculosis: a retrospective study

BMC Infectious Diseases

Research Article

Denise M. Medeiros¹  Andre M. Japiassu¹  José Cerbino¹  Camila Ribeiro¹  Ana Carla Pecego¹  Emersom C. Mesquita¹  Rodrigo T. Amancio¹  Fernando A. Bozza²  Beatriz Grinsztejn³ 

[1] Intensive Care Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, 21045-900, Rio de Janeiro, RJ, Brazil;Intensive Care Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, 21045-900, Rio de Janeiro, RJ, Brazil;Instituto D’Or de Pesquisa e Ensino, Rua Diniz Cordeiro, n° 30, Botafogo, 22281-100, Rio de Janeiro, RJ, Brazil;STD/AIDS Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, 21045-900, Rio de Janeiro, RJ, Brazil;

关键词: HIV;    AIDS;    Tuberculosis;    Critical care;    Patient outcome;   

DOI  :  10.1186/s12879-016-1644-6

 received in 2015-01-08, accepted in 2016-06-08,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundTuberculosis is one of the leading causes of death from infectious diseases worldwide, mainly after the human immunodeficiency virus (HIV) epidemics. Patient with HIV-related illness are more likely to present with severe TB due to immunosuppression. Very few studies have explored HIV/TB co-infection in critically ill patients. The goal of this study was to analyze factors associated with long-term mortality in critically ill patient with HIV-related disease coinfected with TB.MethodsWe conducted a retrospective study in an infectious disease reference center in Brazil that included all patient with HIV-related illness admitted to the ICU with laboratory-confirmed tuberculosis from March 2007 until June 2012. Clinical and laboratory variables were analyzed based on six-month survival.ResultsForty-four patients with HIV-related illness with a confirmed diagnosis of tuberculosis were analyzed. The six-month mortality was 52 % (23 patients). The main causes of admission were respiratory failure (41 %), severe sepsis/septic shock (32 %) and coma/torpor (14 %). The median time between HIV diagnosis and ICU admission was 5 (1–60) months, and 41 % of patients received their HIV infection diagnosis ≤ 30 days before admission. The median CD4 count was 72 (IQR: 23–136) cells/mm3. The clinical presentation was pulmonary tuberculosis in 22 patients (50 %) and disseminated TB in 20 patients (45.5 %). No aspect of TB diagnosis or treatment was different between survivors and nonsurvivors. Neurological dysfunction was more prevalent among nonsurvivors (43 % vs. 14 %, p = 0.04). The nadir CD4 cell count lower than 50 cells/mm3 was independently associated with Six-month mortality (hazard ratio 4.58 [1.64–12.74], p < 0.01), while HIV diagnosis less than three months after positive serology was protective (hazard ratio 0.27, CI 95 % [0.10–0.72], p = 0.01).ConclusionThe Six-month mortality of HIV critically ill patients with TB coinfection is high and strongly associated with the nadir CD4 cell count less than 50 cels/mm3.

【 授权许可】

CC BY   
© Pecego et al. 2016