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Acute kidney injury and other factors associated with mortality in hiv-infected patients
Silva Junior, Geraldo Bezerra da; Parente Filho, Sérgio Luiz Arruda; Soares, Douglas de Sousa; Alencar, Rodrigo da Nóbrega de; Peixoto, Tiago Tomaz Teles; Nogueira, Isadora Sales; Oliveira Filho, Antônio Mendes Ponte de; Menezes, Fernanda Holanda; Cavalcante, Malena Gadelha; Pires Neto, Roberto da Justa; Daher, Elizabeth de Francesco.
  • Silva Junior, Geraldo Bezerra da; University of Fortaleza. Health Sciences Center. School of Medicine. Fortaleza. BR
  • Parente Filho, Sérgio Luiz Arruda; Federal University of Ceará. School of Medicine. Department of Internal Medicine. Fortaleza. BR
  • Soares, Douglas de Sousa; Federal University of Ceará. School of Medicine. Department of Internal Medicine. Fortaleza. BR
  • Alencar, Rodrigo da Nóbrega de; Federal University of Ceará. School of Medicine. Department of Internal Medicine. Fortaleza. BR
  • Peixoto, Tiago Tomaz Teles; Federal University of Ceará. School of Medicine. Department of Internal Medicine. Fortaleza. BR
  • Nogueira, Isadora Sales; Federal University of Ceará. School of Medicine. Department of Internal Medicine. Fortaleza. BR
  • Oliveira Filho, Antônio Mendes Ponte de; Federal University of Ceará. School of Medicine. Department of Internal Medicine. Fortaleza. BR
  • Menezes, Fernanda Holanda; Federal University of Ceará. School of Medicine. Department of Internal Medicine. Fortaleza. BR
  • Cavalcante, Malena Gadelha; Federal University of Ceará. School of Medicine. Medical Sciences and Pharmacology Post-Graduation Programs. Fortaleza. BR
  • Pires Neto, Roberto da Justa; Federal University of Ceará. School of Medicine. Department of Community Health. Fortaleza. BR
  • Daher, Elizabeth de Francesco; Federal University of Ceará. School of Medicine. Department of Internal Medicine. Fortaleza. BR
Rev. Assoc. Med. Bras. (1992) ; 64(6): 509-517, June 2018. tab, graf
Article in English | LILACS | ID: biblio-956489
ABSTRACT
SUMMARY

OBJECTIVE:

HIV-related mortality is still high, especially in developed countries. The aim of this study is to investigate factors associated to death in HIV-infected patients.

METHODS:

This is a cross-sectional study with all HIV adult patients admitted to a tertiary infectious diseases hospital in Fortaleza, Northeast Brazil, from January 2013 to December 2014. Patients were divided into two groups survivors and non-survivors. Demo-graphical, clinical and laboratory data were compared and a logistic regression was performed in order to investigate risk factors for death. P values ≤0.05 were considered statistically significant.

RESULTS:

A total of 200 patients with mean age of 39 years were including in the study, 69.5% males. Fifteen patients (7.5%) died. Non-survivors presented a higher percentage of males (93.3 vs. 67.3%, p = 0.037). Non-survivors presented AKI (73.3 vs. 10.3%, p < 0.001), liver dysfunction (33.3 vs. 11.5, p = 0.031), dyspnea (73.3 vs. 33.0%, p = 0.002) and disorientation (33.3 vs. 12.4%, p = 0.025) more frequently. Non-survivors also had higher levels of urea (73.8 ± 52.7vs. 36.1 ± 29.1 mg/dL, p < 0.001), creatinine (1.98 ± 1.65 vs. 1.05 ± 1.07 mg/dL, p < 0.001), aspartate aminotransferase (130.8 vs. 84.8 U/L, p = 0.03), alanine aminotransferase (115.6 vs. 85.4 U/L, p = 0.045) and lactate dehydrogenase (LDH) (1208 vs. 608 U/L, p = 0.012), as well as lower levels of bicarbonate (18.0 ± 4.7 vs. 21.6 ± 4.6 mEq/L, p = 0.016) and PCO2 (27.8 ± 7.7 vs. 33.0 ± 9.3 mmHg, p = 0.05). In multivariate analysis, disorientation (p = 0.035, OR = 5.523, 95%CI = 1.130 - 26.998), dyspnoea (p = 0.046, OR = 4.064, 95%CI = 1.028 - 16.073), AKI (p < 0.001, OR = 18.045, 95%CI = 4.308 - 75.596) and disseminated histoplasmosis (p = 0.016, OR = 12.696, 95%CI = 1.618 - 99.646) and LDH > 1000 U/L (p = 0.038, OR = 4.854, 95%CI = 1.093 - 21.739) were risk factors for death.]

CONCLUSION:

AKI and disseminated histoplasmosis (DH) were the main risk factors for death in the studied population. Neurologic and respiratory impairment as well as higher levels of LDH also increased mortality in HIV-infected patients.
RESUMO
RESUMO

INTRODUÇÃO:

A mortalidade relacionada ao HIV ainda é alta, especialmente nos países em desenvolvimento. O objetivo deste estudo é investigar os fatores associados ao óbito em pacientes com HIV.

MÉTODOS:

Trata-se de um estudo transversal com todos os pacientes com HIV admitidos consecutivamente em um hospital terciário de doenças infecciosas em Fortaleza, Nordeste do Brasil, entre janeiro de 2013 e dezembro de 2014. Os pacientes foram divididos em dois grupos sobreviventes e não sobreviventes. Dados demográficos, clínicos e laboratoriais foram comparados e análise de regressão logística foi feita para investigação dos fatores de risco para óbito.

RESULTADOS:

Um total de 200 pacientes, com média de idade de 39 anos, foi incluído no estudo, sendo 69,5% do sexo masculino. Óbito ocorreu em 15 pacientes (7,5%). Os não sobreviventes apresentaram maior percentual de homens (93,3 vs. 67,3%, p = 0,037) e um menor tempo de internação (8 ± 6 vs. 18 ± 15 dias, p = 0,005). Na análise multivariada, desorientação (p = 0,035, OR = 5,523), dispneia (p = 0,046, OR = 4,064), LRA (p < 0,001, OR = 18,045), histoplasmose disseminada (p = 0,016, OR = 12,696) e desidrogenase lática (LDH) > 1.000 U/L (p = 0,038, OR = 4,854) foram fatores de risco para óbito.

CONCLUSÕES:

LRA e histoplasmose disseminada foram os principais fatores de risco para óbito na população estudada. Distúrbios neurológicos e respiratórios, bem como níveis elevados de LDH, também estiveram associados com o aumento da mortalidade em pacientes com HIV.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: HIV Infections / Acute Kidney Injury Type of study: Etiology study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Adolescent / Adult / Aged / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2018 Type: Article Affiliation country: Brazil Institution/Affiliation country: Federal University of Ceará/BR / University of Fortaleza/BR

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Full text: Available Index: LILACS (Americas) Main subject: HIV Infections / Acute Kidney Injury Type of study: Etiology study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Adolescent / Adult / Aged / Female / Humans / Male Country/Region as subject: South America / Brazil Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2018 Type: Article Affiliation country: Brazil Institution/Affiliation country: Federal University of Ceará/BR / University of Fortaleza/BR