Research

Impact of HIV/AIDS on care and outcomes of severe sepsis

Joseph M Mrus^1,2,3 , LeeAnn Braun⁴ , Michael S Yi⁵ , Walter T Linde-Zwirble⁶ and Joseph A Johnston⁷

¹Research Physician, Health Services Research and Development, Cincinnati VA Medical Center, Cincinnati, OH, USA

²Assistant Professor, Department of Internal Medicine and Institute for the Study of Health, University of Cincinnati Medical Center, Cincinnati, OH, USA

³Manager, Clinical Development, Infectious Diseases Medicine Development Center – HIV, GlaxoSmithKline, Research Triangle Park, NC, USA

⁴Associate Clinical Development Consultant, Corporate Clinical Operations, Eli Lilly and Company, Indianapolis, IN, USA

⁵Assistant Professor, Department of Internal Medicine and Institute for the Study of Health, University of Cincinnati Medical Center, Cincinnati, OH, USA

⁶Vice President, Chief Science Officer, ZD Associates, LLC, Perkasie, PA, USA

⁷Clinical Research Physician, US Outcomes Research, Lilly Research Laboratories, Indianapolis, IN, USA

author email corresponding author email

Critical Care 2005, 9:R623-R630doi:10.1186/cc3811

Published:	27 September 2005

See related commentary http://ccforum.com/content/9/6/629

Abstract

Introduction

There has been dramatic improvement in survival for patients with HIV/AIDS; however, some studies on patients with HIV/AIDS and serious illness have reported continued low rates of intensive care. The purpose of this study was to examine patterns of care and outcomes for patients with severe sepsis and HIV/AIDS and compare them with those of patients with severe sepsis without HIV/AIDS.

Methods

We assessed data from all 1999 discharge abstracts from all non-federal hospitals in six US states. Patient demographic characteristics, discharge diagnoses, resource use, and outcomes were extracted. Analyses were performed using chi-square, Wilcoxon rank sum, or regression techniques, as appropriate.

Results

We identified 74,020 patients with severe sepsis (7,638 (10.3%) had HIV/AIDS) using ICD-9-CM codes. Patients with severe sepsis and HIV/AIDS had a similar mean length of stay (16.9 days versus 17.7 days; p = 0.0669), had lower mean hospitalization cost ($24,382 versus $30,537; p < 0.0001), were less likely to be admitted to the intensive care unit (37% versus 56%; p < 0.0001), and had a greater mortality (29% versus 20%; p < 0.0001) than those without HIV/AIDS. After adjustment for cohort differences, patients with severe sepsis and HIV/AIDS had increased likelihood of death (OR (95% CI) = 2.41 (2.23–2.61)) and were substantially less likely to be admitted to the intensive care unit (OR (95% CI) = 0.54 (0.51–0.59)). When compared with those with severe sepsis and HIV/AIDS, patients with severe sepsis without HIV/AIDS were universally more likely to be admitted to the intensive care unit, even when they had comorbid illnesses with equal or worse expected in-hospital mortality (e.g., metastatic cancer).

Conclusion

For patients with severe sepsis, there are differences in care and outcomes for those with HIV/AIDS. Further research is needed to examine the delivery of care for patients with severe sepsis and HIV/AIDS.