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