title: Admissions to intensive care unit of HIV-infected patients in the era of highly active antiretroviral therapy: etiology and prognostic factors.
abstract: BACKGROUND
  Although access to highly active antiretroviral therapy (HAART) has prolonged survival and improved life quality, HIV-infected patients with severe immunosuppression or comorbidities may develop complications that require critical care support in intensive care units (ICU). This study aimed to describe the etiology and analyze the prognostic factors of HIV-infected Taiwanese patients in the HAART era.
  
  
  METHODS
  Medical records of all HIV-infected adults who were admitted to ICU at a university hospital in Taiwan from 2001 to 2010 were reviewed to record information on patient demographics, receipt of HAART, and reason for ICU admission. Factors associated with hospital mortality were analyzed.
  
  
  RESULTS
  During the 10-year study period, there were 145 ICU admissions for 135 patients, with respiratory failure being the most common cause (44.4%), followed by sepsis (33.3%) and neurological disease (11.9%). Receipt of HAART was not associated with survival. However, CD4 count was independently predictive of hospital mortality (adjusted odds ratio [AOR], per-10 cells/mm3 decrease, 1.036; 95% confidence interval [CI], 1.003 to 1.069). Admission diagnosis of sepsis was independently associated with hospital mortality (AOR, 2.91; 95% CI, 1.11 to 7.62). A hospital-to-ICU interval of more than 24 hours and serum albumin level (per 1-g/dl decrease) were associated with increased hospital mortality, but did not reach statistical significance in multivariable analysis.
  
  
  CONCLUSIONS
  Respiratory failure was the leading cause of ICU admissions among HIV-infected patients in Taiwan. Outcome during the ICU stay was associated with CD4 count and the diagnosis of sepsis, but was not associated with HAART in this study.
authors.affiliation: Department of Internal Medicine, Far East Memorial Hospital, Nanya South Road, New Taipei City 220, Taiwan.
authors.forename: Hou-Hsien
authors.initials: HH
authors.lastname: Chiang
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Lee
authors.forename: Hsuan-Yu
authors.initials: HY
authors.lastname: Chen
authors.forename: Mao-Yuan
authors.initials: MY
authors.lastname: Chen
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.forename: Szu-Min
authors.initials: SM
authors.lastname: Hsieh
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Chao-Chi
authors.initials: CC
authors.lastname: Ho
authors.forename: Chong-Jen
authors.initials: CJ
authors.lastname: Yu
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology*; D010343:Patient Admission; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D018805:Sepsis / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology