Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort
Abstract Purpose Despite antiviral therapy (ART), 800,000 deaths still occur yearly and globally due to HIV infection. In parallel with the good virological control and the aging of this population, multiple comorbidities [HIV-associated-non-AIDS (HANA) conditions] may now be observed. Methods HIV a...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-023-04325-9 |
| _version_ | 1827984016297426944 |
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| author | Antoine Gaillet Elie Azoulay Etienne de Montmollin Maité Garrouste-Orgeas Yves Cohen Claire Dupuis Carole Schwebel Jean Reignier Shidasp Siami Laurent Argaud Christophe Adrie Bruno Mourvillier Stéphane Ruckly Jean-Marie Forel Jean-Francois Timsit |
| author_facet | Antoine Gaillet Elie Azoulay Etienne de Montmollin Maité Garrouste-Orgeas Yves Cohen Claire Dupuis Carole Schwebel Jean Reignier Shidasp Siami Laurent Argaud Christophe Adrie Bruno Mourvillier Stéphane Ruckly Jean-Marie Forel Jean-Francois Timsit |
| author_sort | Antoine Gaillet |
| collection | DOAJ |
| description | Abstract Purpose Despite antiviral therapy (ART), 800,000 deaths still occur yearly and globally due to HIV infection. In parallel with the good virological control and the aging of this population, multiple comorbidities [HIV-associated-non-AIDS (HANA) conditions] may now be observed. Methods HIV adult patients hospitalized in intensive care unit (ICU) from all the French region from university and non-university hospital who participate to the OutcomeRea™ database on a voluntary basis over a 24-year period. Results Of the 24,298 stays registered, 630 (2.6%) were a first ICU stay for HIV patients. Over time, the mean age and number of comorbidities (diabetes, renal and respiratory history, solid neoplasia) of patients increased. The proportion of HIV diagnosed on ICU admission decreased significantly, while the median duration of HIV disease as well as the percentage of ART-treated patients increased. The distribution of main reasons for admission remained stable over time (acute respiratory distress > shock > coma). We observed a significant drop in the rate of active opportunistic infection on admission, while the rate of active hemopathy (newly diagnosed or relapsed within the last 6 months prior to admission to ICU) qualifying for AIDS increased—nonsignificantly—with a significant increase in the anticancer chemotherapy administration in ICU. Admissions for HANA or non-HIV reasons were stable over time. In multivariate analysis, predictors of 60-day mortality were advanced age, chronic liver disease, past chemotherapy, sepsis-related organ failure assessment score > 4 at admission, hospitalization duration before ICU admission > 24 h, AIDS status, but not the period of admission. Conclusion Whereas the profile of ICU-admitted HIV patients has evolved over time (HIV better controlled but more associated comorbidities), mortality risk factors remain stable, including AIDS status. |
| first_indexed | 2024-04-09T22:53:37Z |
| format | Article |
| id | doaj.art-246d85187c0849b6b06d6f168a0d5180 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-09T22:53:37Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-246d85187c0849b6b06d6f168a0d51802023-03-22T11:21:26ZengBMCCritical Care1364-85352023-03-0127111110.1186/s13054-023-04325-9Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohortAntoine Gaillet0Elie Azoulay1Etienne de Montmollin2Maité Garrouste-Orgeas3Yves Cohen4Claire Dupuis5Carole Schwebel6Jean Reignier7Shidasp Siami8Laurent Argaud9Christophe Adrie10Bruno Mourvillier11Stéphane Ruckly12Jean-Marie Forel13Jean-Francois Timsit14Medical Intensive Care Unit, Henri Mondor University Hospital, APHPMedical Intensive Care Unit, Saint-Louis University Hospital, APHP, Paris UniversityIAME UMR 1137, INSERM, Paris UniversityMedical Unit, French-British Hospital Institute Levallois-PerretMedical-Surgical Intensive Care Unit, Avicenne University Hospital, Paris Seine Saint-Denis Hospital Network, APHPMedical Intensive Care Unit, CHU Clermont-FerrandMedical ICU, Albert Michallon University Hospital, Grenoble 1 UniversityMedical ICU, Nantes University HospitalPolyvalent ICU, Sud Essonne Dourdan-Etampes HospitalMedical Intensive Care Unit, Hospices Civils de Lyon, Edouard Herriot University HospitalPolyvalent ICU, Delafontaine HospitalMedical Intensive Care Unit, Reims University HospitalIAME UMR 1137, INSERM, Paris UniversityMedical ICU, Hôpital Nord University HospitalIAME UMR 1137, INSERM, Paris UniversityAbstract Purpose Despite antiviral therapy (ART), 800,000 deaths still occur yearly and globally due to HIV infection. In parallel with the good virological control and the aging of this population, multiple comorbidities [HIV-associated-non-AIDS (HANA) conditions] may now be observed. Methods HIV adult patients hospitalized in intensive care unit (ICU) from all the French region from university and non-university hospital who participate to the OutcomeRea™ database on a voluntary basis over a 24-year period. Results Of the 24,298 stays registered, 630 (2.6%) were a first ICU stay for HIV patients. Over time, the mean age and number of comorbidities (diabetes, renal and respiratory history, solid neoplasia) of patients increased. The proportion of HIV diagnosed on ICU admission decreased significantly, while the median duration of HIV disease as well as the percentage of ART-treated patients increased. The distribution of main reasons for admission remained stable over time (acute respiratory distress > shock > coma). We observed a significant drop in the rate of active opportunistic infection on admission, while the rate of active hemopathy (newly diagnosed or relapsed within the last 6 months prior to admission to ICU) qualifying for AIDS increased—nonsignificantly—with a significant increase in the anticancer chemotherapy administration in ICU. Admissions for HANA or non-HIV reasons were stable over time. In multivariate analysis, predictors of 60-day mortality were advanced age, chronic liver disease, past chemotherapy, sepsis-related organ failure assessment score > 4 at admission, hospitalization duration before ICU admission > 24 h, AIDS status, but not the period of admission. Conclusion Whereas the profile of ICU-admitted HIV patients has evolved over time (HIV better controlled but more associated comorbidities), mortality risk factors remain stable, including AIDS status.https://doi.org/10.1186/s13054-023-04325-9Human immunodeficiency virus (HIV)Acquired immune deficiency syndrome (AIDS)Antiretroviral therapy (ART)Intensive care unit (ICU)Outcome assessment |
| spellingShingle | Antoine Gaillet Elie Azoulay Etienne de Montmollin Maité Garrouste-Orgeas Yves Cohen Claire Dupuis Carole Schwebel Jean Reignier Shidasp Siami Laurent Argaud Christophe Adrie Bruno Mourvillier Stéphane Ruckly Jean-Marie Forel Jean-Francois Timsit Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort Critical Care Human immunodeficiency virus (HIV) Acquired immune deficiency syndrome (AIDS) Antiretroviral therapy (ART) Intensive care unit (ICU) Outcome assessment |
| title | Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort |
| title_full | Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort |
| title_fullStr | Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort |
| title_full_unstemmed | Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort |
| title_short | Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort |
| title_sort | outcomes in critically ill hiv infected patients between 1997 and 2020 analysis of the outcomerea multicenter cohort |
| topic | Human immunodeficiency virus (HIV) Acquired immune deficiency syndrome (AIDS) Antiretroviral therapy (ART) Intensive care unit (ICU) Outcome assessment |
| url | https://doi.org/10.1186/s13054-023-04325-9 |
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