eprintid: 10190624
rev_number: 9
eprint_status: archive
userid: 699
dir: disk0/10/19/06/24
datestamp: 2024-04-12 14:00:50
lastmod: 2024-04-12 14:00:50
status_changed: 2024-04-12 14:00:50
type: article
metadata_visibility: show
sword_depositor: 699
creators_name: Kanitkar, Tanmay
creators_name: Bakewell, Nicholas
creators_name: Dissanayake, Oshani
creators_name: Symonds, Maggie
creators_name: Rimmer, Stephanie
creators_name: Adlakha, Amit
creators_name: Lipman, Marc CI
creators_name: Bhagani, Sanjay
creators_name: Agarwal, Banwari
creators_name: Sabin, Caroline A
creators_name: Miller, Robert F
title: Improving 1-Year Mortality Following Intensive Care Unit Admission in Adults with HIV: A 20-Year Observational Study
ispublished: inpress
divisions: UCL
divisions: B02
divisions: D01
divisions: G16
keywords: AIDS, APACHE II, CD4+ T-cell count, HIV, antiretroviral therapy, intensive care, intensive care unit, mortality, outcome, people with HIV, survival, viral load
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
abstract: BACKGROUND: Despite widespread use of combination antiretroviral therapy, people with HIV (PWH) continue to have an increased risk of admission to and mortality in the intensive care unit (ICU). Mortality risk after hospital discharge is not well described. Using retrospective data on adult PWH (≥18 years) admitted to ICU from 2000-2019 in an HIV-referral centre, we describe trends in 1-year mortality after ICU admission. METHODS: One-year mortality was calculated from index ICU admission to date of death; with follow-up right-censored at day 365 for people remaining alive at 1 year, or day 7 after ICU discharge if lost-to-follow-up after hospital discharge. Cox regression was used to describe the association with calendar year before and after adjustment for patient characteristics (age, sex, Acute Physiology and Chronic Health Evaluation II [APACHE II] score, CD4+ T-cell count, and recent HIV diagnosis) at ICU admission. Analyses were additionally restricted to those discharged alive from ICU using a left-truncated design, with further adjustment for respiratory failure at ICU admission in these analyses. RESULTS: Two hundred and twenty-one PWH were admitted to ICU (72% male, median [interquartile range] age 45 [38-53] years) of whom 108 died within 1-year (cumulative 1-year survival: 50%). Overall, the hazard of 1-year mortality was decreased by 10% per year (crude hazard ratio (HR): 0.90 (95% confidence interval: 0.87-0.93)); the association was reduced to 7% per year (adjusted HR: 0.93 (0.89-0.98)) after adjustment. Conclusions were similar among the subset of 136 patients discharged alive (unadjusted: 0.91 (0.84-0.98); adjusted 0.92 (0.84, 1.02)). CONCLUSIONS: Between 2000 and 2019, 1-year mortality after ICU admission declined at this ICU. Our findings highlight the need for multi-centre studies and the importance of continued engagement in care after hospital discharge among PWH.
date: 2024-04-02
date_type: published
publisher: SAGE Publications
official_url: https://doi.org/10.1177/08850666241241480
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 2266890
doi: 10.1177/08850666241241480
medium: Print-Electronic
lyricists_name: Miller, Robert
lyricists_id: RFMIL81
actors_name: Miller, Robert
actors_id: RFMIL81
actors_role: owner
full_text_status: public
publication: Journal of Intensive Care Medicine
event_location: United States
issn: 0885-0666
citation:        Kanitkar, Tanmay;    Bakewell, Nicholas;    Dissanayake, Oshani;    Symonds, Maggie;    Rimmer, Stephanie;    Adlakha, Amit;    Lipman, Marc CI;                 ... Miller, Robert F; + view all <#>        Kanitkar, Tanmay;  Bakewell, Nicholas;  Dissanayake, Oshani;  Symonds, Maggie;  Rimmer, Stephanie;  Adlakha, Amit;  Lipman, Marc CI;  Bhagani, Sanjay;  Agarwal, Banwari;  Sabin, Caroline A;  Miller, Robert F;   - view fewer <#>    (2024)    Improving 1-Year Mortality Following Intensive Care Unit Admission in Adults with HIV: A 20-Year Observational Study.                   Journal of Intensive Care Medicine        10.1177/08850666241241480 <https://doi.org/10.1177/08850666241241480>.    (In press).    Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10190624/2/Miller_SAGE%20JICM%20Main%20Document%20-%20Resubmission.pdf