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Original Research |

Survival for Patients With HIV Admitted to the ICU Continues to Improve in the Current Era of Combination Antiretroviral Therapy

Krista Powell, MD, MPH*; J. Lucian Davis, MD, MAS; Alison M. Morris, MD, MS; Amy Chi, MD; Matthew R. Bensley, RN; Laurence Huang, MD, FCCP
Author and Funding Information

*From the Department of Medicine (Drs. Powell, Davis, and Huang), University of California San Francisco, San Francisco, CA; the HIV/AIDS Division (Mr. Bensley), San Francisco General Hospital, San Francisco, CA; the Division of Pulmonary and Critical Care Medicine (Dr. Morris), University of Pittsburgh, Pittsburgh, PA; and the Division of Pulmonary and Critical Care Medicine (Dr. Chi), Boston University, Boston, MA.

Correspondence to: Krista Powell, MD, MPH, HIV/AIDS Division, Ward 84, San Francisco General Hospital, 995 Potrero Ave, San Francisco, CA 94110; e-mail: kpow05@gmail.com

*Values are given as No. (%), unless otherwise indicated.

†Values correspond to the F-statistic for linear regression. A p value < 0.05 suggests that a linear trend is present.

*Values are given as mean (range) or No. (%), unless otherwise indicated. LDH = lactate dehydrogenase; MSM = men who have sex with men; IDU = injection drug users.

†Eleven ICU admissions for five transgender patients were excluded from gender-stratified analysis.

‡Data were available for 265 ICU admissions.

§Values are given as median (interquartile range).

‖Values are given as mean log (SD). Data were available for 211 ICU admissions.

¶Values are given as mean (SD). Data were available for 273 ICU admissions.

#Data were available for 184 ICU admissions.

**Data were available for 261 ICU admissions.

*CI = confidence interval; OR = odds ratio; NA = not applicable (data for statistically insignificant predictors were not included). See Table 2 for abbreviations not used in the text.

†Wald p values correspond to univariate analyses.

‡Wald p values correspond to multivariate model, which excludes APACHE II scores due to collinearity with the included variables.

§Other diagnoses include GI bleeding, cardiac conditions, metabolic disorders, trauma, and postoperative care.

The contents of this study are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources of the National Institutes of Health. Information on the National Center for Research Resources is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.

This research was funded by NIH grants 1F32HL088990 (J.L.D.), 1R01HL090339 (A.M.), 5K24HL087713 (L.H.), and 1R01HL090335 (L.H.). This project was also supported by grant No. 1 UL1 RR024131–01 from the National Center for Research Resources, a component of the NIH, and by the NIH Roadmap for Medical Research.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

For editorial comment see page 1


The contents of this study are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources of the National Institutes of Health. Information on the National Center for Research Resources is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.

The contents of this study are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources of the National Institutes of Health. Information on the National Center for Research Resources is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.

This research was funded by NIH grants 1F32HL088990 (J.L.D.), 1R01HL090339 (A.M.), 5K24HL087713 (L.H.), and 1R01HL090335 (L.H.). This project was also supported by grant No. 1 UL1 RR024131–01 from the National Center for Research Resources, a component of the NIH, and by the NIH Roadmap for Medical Research.

This research was funded by NIH grants 1F32HL088990 (J.L.D.), 1R01HL090339 (A.M.), 5K24HL087713 (L.H.), and 1R01HL090335 (L.H.). This project was also supported by grant No. 1 UL1 RR024131–01 from the National Center for Research Resources, a component of the NIH, and by the NIH Roadmap for Medical Research.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

For editorial comment see page 1

For editorial comment see page 1


Chest. 2009;135(1):11-17. doi:10.1378/chest.08-0980
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Background:  The combination antiretroviral therapy (ART) era (1996 to the present) has been associated with improved survival among HIV-infected outpatients, but ICU data from 2000 to the present are limited.

Methods:  We conducted a retrospective study of HIV-infected adults who had been admitted to the ICU at San Francisco General Hospital (from 2000 to 2004). The primary outcome was survival to hospital discharge.

Results:  During the 5-year study period, there were 311 ICU admissions for 281 patients. Respiratory failure remained the most common indication for ICU admission (42% overall), but the proportion of patients with respiratory failure decreased each year from 52 to 34% (p = 0.02). Hospital survival ratios significantly increased during the 5-year period (p = 0.001). ART use at ICU admission was not associated with survival, but it was associated with higher CD4 cell counts, lower plasma HIV RNA levels, higher serum albumin levels, and lower proportions with AIDS-associated ICU admission diagnoses and with Pneumocystis pneumonia. In a multivariate analysis, a higher serum albumin level (adjusted odds ratio [AOR], 2.08; 95% confidence interval [CI], 1.41 to 3.06; p = 0.002) and the absence of mechanical ventilation (AOR, 6.11; 95% CI, 2.73 to 13.72; p < 0.001) were associated with survival.

Conclusions:  In this sixth in a series of consecutive studies started in 1981, we found that the epidemiology of ICU admission diagnoses continues to change. Our study also found that survival for critically ill HIV-infected patients continues to improve in the current era of ART. Although ART use was not associated with survival, it was associated with predictors that were associated with survival in a multivariate analysis.

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