Title Kliničke značajke i ishodi intenzivnog liječenja bolesnika s HIV/AIDS-om Title (english) Clinical characteristics and intensive care treatment outcomes for HIV/ AIDS patients Author Filip Glavač Mentor Marija Santini (mentor)Committee member Josip Begovac (predsjednik povjerenstva)Committee member Goran Tešović (član povjerenstva)Committee member Marija Santini (član povjerenstva)Granter University of Zagreb Defense date and country 2021-07-16, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Bolesnici s HIV/AIDS-om liječeni u jedinicama intenzivne medicine u eri antiretrovirusne terapije predstavljaju izazov u praksi liječnika intenzivista u svijetu i Hrvatskoj. U ovom radu istraživali smo kliničke značajke i ishode intenzivnog liječenja bolesnika s HIV/AIDS-om liječenih u Zavodu za intenzivnu medicinu i neuroinfektologiju Klinike za infektivne bolesti „Dr. Fran Mihaljević“ u Zagrebu, od 2015. do 2019. godine. Prikupili smo opće demografske i epidemiološke značajke, značajke HIV infekcije te podatke vezane uz intenzivno liječenje u Zavodu. Bolesnike uključene u studiju pratili smo do 31.12.2020. godine te odredili njihove kratkoročne i dugoročne ishode. Od ukupno 2003 liječenih u Zavodu identificirano je 37 bolesnika s HIV/AIDS-om, od kojih je 19 (51.4%) bilo novodijagnosticirano. Najčešći razlog primitka u Zavod bila je pneumonija uzrokovana Pneumocystis jirovecii u 11 (29.7%) bolesnika. Među 14 (37.8%) bolesnika kojima je otprije poznat HIV-status razlog prijema bila su različita stanja nevezana uz AIDS, najčešće sepsa i septički šok u 4 (10.8%) slučajeva. Invazivnu mehaničku ventilaciju je bilo potrebno primijeniti kod 27 (73.0%) bolesnika. Tijekom liječenja u Zavodu 28 (75.7%) bolesnika je primalo antiretrovirusnu terapiju. Smrtnost pri otpustu iz Zavoda iznosila je 40.5% , dok je smrtnost po završetku razdoblja praćenja iznosila 56.8%. Funkcionalni status promatran je pomoću modificirane Rankinove skale čiji je medijan pri otpustu iznosio 4 (0 - 6), a po završetku razdoblja praćenja 2 (0 – 6). Razmatrana je povezanost vjerojatnosti preživljenja s dobi ≥ 50 godina, dobi ≥ 60 godina, razinom CD4+ limfocita u krvi ≥ 50/mm3, razinom HIV-RNK u krvi ≥ 1000 c/mL i primjenom invazivne mehaničke ventilacije, međutim statistički nije dokazana. Unatoč visokoj smrtnosti tijekom liječenja, bolesnici s HIV/AIDS-om mogu imati povoljne kratkoročne i dugoročne ishode liječenja u jedinicama intenzivnog liječenja.
Abstract (english) Patients with HIV/AIDS treated in intensive care units in the era of antiretroviral therapy represent a global challenge in the practice of intensive care physicians as well as in Croatia. In this research, we investigated the clinical features and outcomes of intensive care of HIV/AIDS patients treated at the Department of Intensive Care and Neuroinfectology of the Clinic for Infectious Diseases "Dr. Fran Mihaljević ”in Zagreb, from 2015 to 2019. We collected general demographic and epidemiological features, features regarding HIV infection and data related to intensive care. Patients included in the study were followed until 31.12.2020 and their short-term and long-term outcomes were determined. Out of a total of 2003 treated at the Department, 37 patients with HIV/AIDS were identified, of which 19 (51.4%) were newly diagnosed. The most common reason for admission to the Department was pneumonia caused by Pneumocystis jirovecii in 11 (29.7%) patients. Among 14 (37.8%) previously diagnosed patients, the reason for admission were various non-AIDS events, most often sepsis and septic shock in 4 (10.8%) cases. Invasive mechanical ventilation was required in 27 (73.0%) patients. During treatment at the Department, 28 (75.7%) patients received antiretroviral therapy. Mortality at discharge from the Department was 40.5%, while mortality at the end of follow - up was 56.8%. Functional status was observed using a modified Rankin scale whose median at discharge was 4 (0 - 6) and at the end of the follow - up period 2 (0 - 6). The association of survival probability with age ≥ 50 years, age ≥ 60 years, blood CD4+ lymphocyte level ≥ 50 / mm3, blood HIV-RNA level ≥ 1000 c / mL and the use of invasive mechanical ventilation was considered, but not statistically proven. Despite high mortality during treatment, HIV/AIDS patients can have favorable short-term and long-term treatment outcomes in intensive care units.
Keywords
HIV
AIDS
intenzivno liječenje
antiretrovirusna terapija
ishodi liječenja
Keywords (english)
HIV
AIDS
intensive care
antiretroviral therapy
outcomes
Language croatian URN:NBN urn:nbn:hr:105:187339 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2022-02-03 11:26:01
