Mortality, survival and prognostic factors of people with AIDS in intensive care unit

Cunha, Gilmara Holanda da; Lima, Reângela Cíntia Rodrigues de Oliveira; Lopes, Marcos Venícios de Oliveira; Galvão, Marli Teresinha Gimeniz; Siqueira, Larissa Rodrigues; Fontenele, Marina Soares Monteiro

doi:10.1590/1980-220X-REEUSP-2021-0121

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/1980-220X-REEUSP-2021-0121 copy

Mortality, survival and prognostic factors of people with AIDS in intensive care unit

Mortalidade, sobrevida e fatores prognósticos de pessoas com aids em unidade de terapia intensiva

Mortalidad, supervivencia y factores pronósticos de las personas con SIDA en la unidad de cuidados intensivos

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze mortality, survival and prognostic factors of patients with AIDS in Intensive Care Unit (ICU).

Method:

Retrospective cohort study with a sample of 202 patients with AIDS in ICU, whose sociodemographic, epidemiological, and clinical characteristics were obtained from medical records and assessed.

Results:

Patients were mostly male (73.8%) and drug users (59.4%), with no regular health follow-up (61.4%) and no adherence to antiretrovirals (40.6%), presenting low CD4+ T lymphocyte count (94.0%) and high viral load (44.6%). The main causes of hospitalization were sepsis and respiratory and renal insufficiency. The mean duration of hospitalization was 11.9 days (p = 0.0001), with a 41.6% survival; 58.5% died in the ICU. Sepsis upon admission (p < 0.001), pressure injury (p = 0.038), sexual exposure (p = 0.002), high viral load (p = 0.00001) and prolonged hospitalization (p < 0.001) increased the risk of death.

Conclusion:

Most patients had no regular health follow-up, were drug users and presented low CD4+ T lymphocyte count and high viral load. The high mortality indicated that antiretroviral adherence is essential to reduce viral resistance, opportunistic diseases, and mortality.

DESCRIPTORS
Acquired Immunodeficiency Syndrome; Mortality; Survival; Intensive Care Units

Characteristics	N	%
Years of study
≤8	159	78.7
>8	43	21.3
Marital status
Single	133	65.9
Married	67	33.2
Uninformed	2	1.0
Street dwellers	10	5.0
Alcohol user	77	38.1
Prisoner	4	2.0
Immigrant	1	0.5
Illicit drug user
Marijuana	3	1.5
Cocaine	12	5.9
Crack	26	12.9
Inhalants	2	1.0
Exposure category
Sexual	182	90.1
Blood exposure	1	0.5
Vertical transmission	4	2.0
Uninformed	15	7.4
Sexual orientation
Heterosexual	138	68.3
Homosexual	48	23.8
Bisexual	02	1.0
Uninformed	14	6.9
Antiretroviral use time (in months)
<12	142	70.2
13–36	8	4.0
>36	52	25.8
Abandonment of antiretroviral therapy
No	120	59.4
Yes	86	40.6
Regular follow-up of health care
No	124	61.4
Yes	77	38.1
Uninformed	1	0.5
CD4+ T lymphocyte count (cells/mm3)
≤350	191	94.0
>350	12	6.0
Viral load (copies/mL)
<50 (undetectable)	90	44.6
50–100,000	59	29.2
>100,000	53	26.2

Factors and pathological conditions	Odds ratio	95% confidence interval	p value^* *Chi-Square Test.
Mechanical ventilation	1.917	0.418–8.798	0.453
Sepsis	4.987	2.715–9.159	<0.001
Pulmonary tuberculosis	1.169	0.667–2.049	0.619
Renal replacement therapy	2.744	1.505–5.000	0.001
Histoplasmosis	2.045	0.978–4.280	0.055
Esophageal candidiasis	1.006	0.502–2.018	0.986
Aspiration pneumonia	1.182	0.555–2.519	0.664
Herpes simplex	0.919	0.420–2.012	0.833
Neurotoxoplasmosis	0.676	0.296–1.544	0.351
Pneumocystis jiroveci pneumonia	1.122	0.461–2.728	0.800
Cytomegalovirus	0.943	0.378–2.352	0.900
Cryptococcosis	0.599	0.208–1.721	0.337
Isosporidiosis	0.820	0.265–2.533	0.730
Herpes zoster	0.554	0.144–2.129	0.384
Hepatitis B	0.171	0.019–1.558	0.163
Mycobacteriosis	2.912	0.320–26.534	0.321

ICU^* Intensive Care Unit; *Confidence Interval. stay (days)	Death event in the sample (N = 118)	Number of events (deaths)	Survival	Standard error	95%CI^** Intensive Care Unit; *Confidence Interval. Lower	95%CI Upper
0	202	2	0.990	0.007	0.977	1.000
1	200	7	0.955	0.015	0.927	0.984
2	188	10	0.905	0.021	0.865	0.946
3	176	17	0.817	0.028	0.765	0.873
4	150	10	0.763	0.031	0.705	0.825
5	138	5	0.735	0.032	0.675	0.800
6	127	3	0.718	0.033	0.656	0.785
7	119	8	0.670	0.035	0.605	0.741
8	106	3	0.651	0.035	0.585	0.724
9	99	2	0.637	0.036	0.571	0.712
10	96	4	0.611	0.037	0.543	0.687
11	88	6	0.569	0.038	0.500	0.649
12	81	3	0.548	0.038	0.478	0.629
13	76	3	0.526	0.039	0.456	0.609
14	68	2	0.511	0.039	0.440	0.594
15	64	2	0.495	0.040	0.423	0.579
16	59	3	0.470	0.040	0.397	0.556
17	55	2	0.453	0.041	0.380	0.540
18	48	3	0.424	0.041	0.351	0.513
19	43	3	0.395	0.042	0.321	0.486
21	33	2	0.371	0.042	0.296	0.464
22	31	1	0.359	0.043	0.284	0.453
23	28	3	0.321	0.044	0.246	0.418
24	24	4	0.267	0.044	0.194	0.368
27	20	1	0.254	0.044	0.181	0.355
28	17	2	0.224	0.043	0.153	0.327
29	14	1	0.208	0.043	0.139	0.312
30	13	3	0.160	0.041	0.097	0.264
33	9	1	0.142	0.040	0.082	0.247
44	4	1	0.107	0.043	0.048	0.235
57	1	1	0	–	–	–

Variable	Coefficient	HR^** Intensive care unit; *Hazard ratio; †Confidence interval; ‡Chi-square test; §Degrees of freedom.	95% CI^† Intensive care unit; *Hazard ratio; †Confidence interval; ‡Chi-square test; §Degrees of freedom.	z	p value^‡ Intensive care unit; *Hazard ratio; †Confidence interval; ‡Chi-square test; §Degrees of freedom.
ICU^* Intensive care unit; *Hazard ratio; †Confidence interval; ‡Chi-square test; §Degrees of freedom. stay (days)	0.28	1.32	1.25–1.38	10.71	<0.001
Sepsis on admission	1.43	4.18	2.14–8.13	4.21	<0.001
Exposure category
Sexual exposure	1.98	7.21	2.00–25.91	3.02	0.002
Vertical transmission	1.71	5.52	0.43–71.14	1.31	0.191
Blood exposure	3.85	46.78	4.13–529.52	3.11	0.002
Pressure injury	0.70	2.01	1.04–3.90	2.08	0.038
Neurological disorder	1.32	3.74	1.33–10.56	2.49	0.013
Neurological disorder on admission	−1.11	0.33	0.11–0.97	−2.02	0.043
Esophageal candidiasis	−1.12	0.33	0.16–0.68	−2.99	0.003
Viral load	0.00	1.00	1.00–1.00	3.23	0.001
Use of efavirenz	0.54	1.72	1.06–2.82	2.18	0.030
Adjustment statistics
Agreement	0.891	Confidence interval 95%: 0.823–0.954
R²	0.694	Maximum possible: 0.994
Likelihood ratio test			239.5	df^§ Intensive care unit; *Hazard ratio; †Confidence interval; ‡Chi-square test; §Degrees of freedom. :11	P < 0.001
Wald test			148.8	df: 11	P < 0.001
Test score (log-rank)			168.6	df: 11	P < 0.001

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E-mail: reeusp@usp.br

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[1] Corresponding author: Gilmara Holanda da Cunha, Rua Alexandre Baraúna, 115, Rodolfo Teófilo, 60430-160, Fortaleza, CE, Brazil, gilmaraholandaufc@yahoo.com.br