SEARCHCOHORTcritical care, infectious disease

cohort·critical care, infectious disease, immunology, epidemiology, observational study·PMC10012467

Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort

Critical Care · 15 authors, 15 centres

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TL;DR

The study found that while patient characteristics evolved—with older age, more comorbidities, and better HIV control—predictors of 60-day mortality, including AIDS status, remained stable over time.

Full summary

530 CHARS

The results show a significant increase over time in the mean age and prevalence of comorbidities such as diabetes, renal history, and solid neoplasia. Conversely, there was a significant decrease in the proportion of HIV diagnosed on ICU admission and in the rate of active opportunistic infections on admission. The findings suggest that while the clinical profile of ICU-admitted HIV patients has shifted towards better viral control and more non-AIDS comorbidities, traditional mortality risk factors have remained consistent.

STUDY TYPE

cohort

SPECIALTY

critical care

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10012467

Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort

Critical Care

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ABSTRACT

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. Keywords: Human immunodeficiency virus (HIV), Acquired immune deficiency syndrome (AIDS), Antiretroviral therapy (ART), Intensive care unit (ICU), Outcome assessment

CITATION EXPORT

Antoine Gaillet, Elie Azoulay, Etienne de Montmollin et al.. Outcomes in critically Ill HIV-infected patients between 1997 and 2020: analysis of the OUTCOMEREA multicenter cohort. Critical Care. (2023). https://doi.org/10.1186/s13054-023-04325-9

AUTHORS

15 · 15 CENTRES

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

1Medical Intensive Care Unit, Henri Mondor University Hospital, APHP, 1 Rue Gustave Eiffel, 94010 Créteil Cedex, France
2IAME UMR 1137, INSERM, Paris University, 75018 Paris, France
3Medical Intensive Care Unit, Saint-Louis University Hospital, APHP, Paris University, 1 Avenue Claude Vellefaux, 75010 Paris, France
4Medical Intensive Care Unit, Paris Diderot University/Bichat University Hospital, APHP, Paris, France
5Medical Unit, French-British Hospital Institute Levallois-Perret, Levallois-Perret, France
6Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Paris Seine Saint-Denis Hospital Network, APHP, Bobigny, France
7Medical Intensive Care Unit, CHU Clermont-Ferrand, Clermont-Ferrand, France
8Nutrition Humaine Unit, INRAe, CRNH Auvergne, Clermont Auvergne University, 63000 Clermont-Ferrand, France
9Medical ICU, Albert Michallon University Hospital, Grenoble 1 University, Grenoble, France
10Medical ICU, Nantes University Hospital, Nantes, France
11Polyvalent ICU, Sud Essonne Dourdan-Etampes Hospital, Dourdan, France
12Medical Intensive Care Unit, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
13Polyvalent ICU, Delafontaine Hospital, Saint-Denis, France
14Medical Intensive Care Unit, Reims University Hospital, Reims, France
15Medical ICU, Hôpital Nord University Hospital, Marseille, France