背景:在资源有限的环境中,HIV感染者(PLHIV)的入院结果尚未得到充分研究。我们描述了乌干达三级公立医院收治的PLHIV的住院死亡率和相关的临床人口统计学因素。
方法:我们对2020年3月至2023年3月在Kiruddu国家转诊医院收治的PLHIV常规收集的数据进行了横断面分析。我们估计了住院期间死亡的PLHIV比例,并进行逻辑回归建模以确定死亡率的预测因素。
结果:在5,827例住院的PLHIV中,中位年龄为39岁(四分位距[IQR]31~49岁),女性为3,293人(56.51%).中位CD4+细胞计数为109个细胞/微升(IQR25-343)。入院时,3,710(63.67%)积极接受抗逆转录病毒治疗(ART);1,144(19.63%)中断ART>3个月,973(16.70%)未接受ART治疗。住院死亡率为26%(1,524),中位死亡时间为3天(IQR1-7)。与死亡率相关的因素(调整后的比值比)包括ART中断,1.33,95%置信区间(CI)1.13-1.57,p0.001;CD4+计数≤200个细胞/µL1.59,95CI1.33-1.91,p<0.001;未记录的CD4+细胞计数状态2.08,95CI1.73-2.50,p<0.001;功能状态7.35,95CI6.42-8.41,p<0.001;COVID-191.95CI30p<0.001-995-9
结论:1/4的患者在住院期间死亡。识别风险因素(如ART中断、功能损害,低/未记录的CD4+细胞计数),合并感染和肝病的早期诊断和治疗可以改善预后.
BACKGROUND: Hospital admission outcomes for people living with HIV (PLHIV) in resource-limited settings are understudied. We describe in-hospital mortality and associated clinical-demographic factors among PLHIV admitted at a tertiary-level public hospital in Uganda.
METHODS: We performed a cross-sectional analysis of routinely collected data for PLHIV admitted at Kiruddu National Referral Hospital between March 2020 and March 2023. We estimated the proportion of PLHIV who had died during hospitalization and performed logistic regression modelling to identify predictors of mortality.
RESULTS: Of the 5,827 hospitalized PLHIV, the median age was 39 years (interquartile range [IQR] 31-49) and 3,293 (56.51%) were female. The median CD4 + cell count was 109 cells/µL (IQR 25-343). At admission, 3,710 (63.67%) were active on antiretroviral therapy (ART); 1,144 (19.63%) had interrupted ART > 3 months and 973 (16.70%) were ART naïve. In-hospital mortality was 26% (1,524) with a median time-to-death of 3 days (IQR 1-7). Factors associated with mortality (with adjusted odds ratios) included ART interruption, 1.33, 95% confidence intervals (CI) 1.13-1.57, p 0.001; CD4 + counts ≤ 200 cells/µL 1.59, 95%CI 1.33-1.91, p < 0.001; undocumented CD4 + cell count status 2.08, 95%CI 1.73-2.50, p < 0.001; impaired function status 7.35, 95%CI 6.42-8.41, p < 0.001; COVID-19 1.70, 95%CI 1.22-2.37, p 0.002; liver disease 1.77, 95%CI 1.36-2.30, p < 0.001; co-infections 1.53, 95%CI 1.32-1.78, p < 0.001; home address > 20 km from hospital 1.23, 95%CI 1.04-1.46, p 0.014; hospital readmission 0.7, 95%CI 0.56-0.88, p 0.002; chronic lung disease 0.62, 95%CI 0.41-0.92, p 0.019; and neurologic disease 0.46, 95%CI 0.32-0.68, p < 0.001.
CONCLUSIONS: One in four admitted PLHIV die during hospitalization. Identification of risk factors (such as ART interruption, function impairment, low/undocumented CD4 + cell count), early diagnosis and treatment of co-infections and liver disease could improve outcomes.