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CURB-65 and Other Markers of Illness Severity in Community-Acquired Pneumonia Among HIV-Positive Patients

2016-10Journal article Open access
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dc.contributor.authorAlmeida, A
dc.contributor.authorAlmeida, AR
dc.contributor.authorCastelo Branco, S
dc.contributor.authorVesza, Z
dc.contributor.authorPereira, R
dc.date.accessioned2016-10-14T15:31:12Z
dc.date.available2016-10-14T15:31:12Z
dc.date.issued2016-10
dc.description.abstractAs the relative burden of community-acquired bacterial pneumonia among HIV-positive patients increases, adequate prediction of case severity on presentation is crucial. We sought to determine what characteristics measurable on presentation are predictive of worse outcomes. We studied all admissions for community-acquired bacterial pneumonia over one year at a tertiary centre. Patient demographics, comorbidities, HIV-specific markers and CURB-65 scores on Emergency Department presentation were reviewed. Outcomes of interest included mortality, bacteraemia, intensive care unit admission and orotracheal intubation. A total of 396 patients were included: 49 HIV-positive and 347 HIV-negative. Mean CURB-65 score was 1.3 for HIV-positive and 2.2 for HIV-negative patients (p < 0.0001), its predictive value for mortality being maintained in both groups (p = 0.03 and p < 0.001, respectively). Adjusting for CURB-65 scores, HIV infection by itself was only associated with bacteraemia (adjusted odds ratio [AOR] 7.1, 95% CI [2.6-19.5]). Patients with < 200 CD4 cells/µL presented similar CURB-65 adjusted mortality (aOR 1.7, 95% CI [0.2-15.2]), but higher risk of intensive care unit admission (aOR 5.7, 95% CI [1.5-22.0]) and orotracheal intubation (aOR 9.1, 95% CI [2.2-37.1]), compared to HIV-negative patients. These two associations were not observed in the > 200 CD4 cells/µL subgroup (aOR 2.2, 95% CI [0.7-7.6] and aOR 0.8, 95% CI [0.1-6.5], respectively). Antiretroviral therapy and viral load suppression were not associated with different outcomes (p > 0.05). High CURB-65 scores and CD4 counts < 200 cells/µL were both associated with worse outcomes. Severity assessment scales and CD4 counts may both be helpful in predicting severity in HIV-positive patients presenting with community-acquired bacterial pneumonia.pt_PT
dc.identifier.citationInt J STD AIDS. 2016 Oct;27(11):998-1004pt_PT
dc.identifier.doi10.1177/0956462415605232pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/2564
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSAGE Publicationspt_PT
dc.subjectHSM MEDpt_PT
dc.subjectHCC UCIpt_PT
dc.subjectAIDS-Related Opportunistic Infections/complicationspt_PT
dc.subjectAIDS-Related Opportunistic Infections/epidemiologypt_PT
dc.subjectAIDS-Related Opportunistic Infections/mortalitypt_PT
dc.subjectAnti-Retroviral Agents/therapeutic usept_PT
dc.subjectAntiretroviral Therapy, Highly Activept_PT
dc.subjectBiomarkers/bloodpt_PT
dc.subjectCommunity-Acquired Infections/diagnosispt_PT
dc.subjectCommunity-Acquired Infections/epidemiology
dc.subjectCommunity-Acquired Infections/mortality
dc.subjectHIV Infections/complications
dc.subjectHIV Infections/drug therapy
dc.subjectHospitalization
dc.subjectIntensive Care Units
dc.subjectPneumonia/diagnosis
dc.subjectPneumonia/epidemiology
dc.subjectPneumonia/mortality
dc.subjectRetrospective Studies
dc.subjectSeverity of Illness Index
dc.titleCURB-65 and Other Markers of Illness Severity in Community-Acquired Pneumonia Among HIV-Positive Patientspt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1004pt_PT
oaire.citation.issue11pt_PT
oaire.citation.startPage998pt_PT
oaire.citation.titleInternational Journal of STD and AIDSpt_PT
oaire.citation.volume27pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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