HIV positive patients in intensive care - a retrospective chart review

 

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dc.contributor.advisor Raine, Richard en_ZA
dc.contributor.author Mkoko, Philasande en_ZA
dc.date.accessioned 2016-07-28T12:20:40Z
dc.date.available 2016-07-28T12:20:40Z
dc.date.issued 2016 en_ZA
dc.identifier.citation Mkoko, P. 2016. HIV positive patients in intensive care - a retrospective chart review. University of Cape Town. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/20959
dc.description.abstract Background: The indications for and outcomes of intensive care unit (ICU) admission of HIV - infected patients in resource - poor settings like Sub - Saharan Africa are unknown. Methods: We reviewed case records of HIV - infected patients admitted to the medical and surgical ICUs at Groote Schuur Hospital, South Africa from 1 January 2012 to 31 December 2012. HIV infection was defined as two positive antibody tests. Results: Seventy seven HIV - infected patients were admitted to ICU, 2 were younger than 18 years and were excluded from the final analysis. HIV infection was newly diagnosed in 37.3% of the patients admitted during this period. HIV - positive patients had a mean (± standard deviation) CD 4 count of 293.9 × 10 6 /L ± 247.2 × 10 6 /L. Respiratory illness accounted for 30.7% of ICU admissions, community - acquired pneumonia was responsible for the majority of the respiratory cases. ICU and hospital mortality was 25.3% and 34.7% respectively. Predictors of ICU mortality included an APACHE Ι Ι score >13 (Odds Ratio {OR } , 1.4; 95% confidence interval {CI } 1.1 - 1.7; p value 0.015), receipt of renal replacement therapy (OR, 2.2; 95% CI 1.2 - 4.1; P 0.018) and receipt of inotropes (OR 2.3; 95% CI 1.6 - 3.4; P <0.001). Predictors of hospital mortality were severe sepsis on admission (OR, 2.8; 95% CI 0.9 - 9.1;p 0.07), receipt of renal replacement therapy (OR, 1.9; 95% CI 1.0 - 3.6; p 0.056), receipt of inotropic support (OR, 2.0; 95% CI 1.4 - 3.2; p 0.001). Use of highly active antiretroviral therapy, CD4 count, detectable HIV viral load and the diagnoses at ICU admission did not predict ICU or hospital mortality. Conclusion Respiratory illnesses remain the main indication for ICU in HIV infected patients. HIV is diagnosed late with patients presenting in dire straits. Receipt of HAART, CD4 count and the diagnoses at ICU admission are not predictors of ICU or hospital mortality, but rather the severity of illness as indicated by a high APACHE ΙΙ score, multiple organ dysfunction requiring inotropic support and renal replacement. en_ZA
dc.language.iso eng en_ZA
dc.subject.other Medicine en_ZA
dc.title HIV positive patients in intensive care - a retrospective chart review en_ZA
dc.type Master Thesis
uct.type.publication Research en_ZA
uct.type.resource Thesis en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Medicine en_ZA
dc.type.qualificationlevel Masters
dc.type.qualificationname MMed en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Mkoko, P. (2016). <i>HIV positive patients in intensive care - a retrospective chart review</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/20959 en_ZA
dc.identifier.chicagocitation Mkoko, Philasande. <i>"HIV positive patients in intensive care - a retrospective chart review."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2016. http://hdl.handle.net/11427/20959 en_ZA
dc.identifier.vancouvercitation Mkoko P. HIV positive patients in intensive care - a retrospective chart review. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2016 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/20959 en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Mkoko, Philasande AB - Background: The indications for and outcomes of intensive care unit (ICU) admission of HIV - infected patients in resource - poor settings like Sub - Saharan Africa are unknown. Methods: We reviewed case records of HIV - infected patients admitted to the medical and surgical ICUs at Groote Schuur Hospital, South Africa from 1 January 2012 to 31 December 2012. HIV infection was defined as two positive antibody tests. Results: Seventy seven HIV - infected patients were admitted to ICU, 2 were younger than 18 years and were excluded from the final analysis. HIV infection was newly diagnosed in 37.3% of the patients admitted during this period. HIV - positive patients had a mean (± standard deviation) CD 4 count of 293.9 × 10 6 /L ± 247.2 × 10 6 /L. Respiratory illness accounted for 30.7% of ICU admissions, community - acquired pneumonia was responsible for the majority of the respiratory cases. ICU and hospital mortality was 25.3% and 34.7% respectively. Predictors of ICU mortality included an APACHE Ι Ι score >13 (Odds Ratio {OR } , 1.4; 95% confidence interval {CI } 1.1 - 1.7; p value 0.015), receipt of renal replacement therapy (OR, 2.2; 95% CI 1.2 - 4.1; P 0.018) and receipt of inotropes (OR 2.3; 95% CI 1.6 - 3.4; P <0.001). Predictors of hospital mortality were severe sepsis on admission (OR, 2.8; 95% CI 0.9 - 9.1;p 0.07), receipt of renal replacement therapy (OR, 1.9; 95% CI 1.0 - 3.6; p 0.056), receipt of inotropic support (OR, 2.0; 95% CI 1.4 - 3.2; p 0.001). Use of highly active antiretroviral therapy, CD4 count, detectable HIV viral load and the diagnoses at ICU admission did not predict ICU or hospital mortality. Conclusion Respiratory illnesses remain the main indication for ICU in HIV infected patients. HIV is diagnosed late with patients presenting in dire straits. Receipt of HAART, CD4 count and the diagnoses at ICU admission are not predictors of ICU or hospital mortality, but rather the severity of illness as indicated by a high APACHE ΙΙ score, multiple organ dysfunction requiring inotropic support and renal replacement. DA - 2016 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - HIV positive patients in intensive care - a retrospective chart review TI - HIV positive patients in intensive care - a retrospective chart review UR - http://hdl.handle.net/11427/20959 ER - en_ZA


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