title: Impact of HIV on inpatient mortality and complications in stroke in Thailand: a National Database Study.
abstract: The co-existence of stroke and HIV has increased in recent years, but the impact of HIV on post-stroke outcomes is poorly understood. We examined the impact of HIV on inpatient mortality, length of acute hospital stay and complications (pneumonia, respiratory failure, sepsis and convulsions), in hospitalized strokes in Thailand. All hospitalized strokes between 1 October 2004 and 31 January 2013 were included. Data were obtained from a National Insurance Database. Characteristics and outcomes for non-HIV and HIV patients were compared and multivariate logistic and linear regression models were constructed to assess the above outcomes. Of 610 688 patients (mean age 63·4 years, 45·4% female), 0·14% (866) had HIV infection. HIV patients were younger, a higher proportion were male and had higher prevalence of anaemia (P < 0·001) compared to non-HIV patients. Traditional cardiovascular risk factors, hypertension and diabetes, were more common in the non-HIV group (P < 0·001). After adjusting for age, sex, stroke type and co-morbidities, HIV infection was significantly associated with higher odds of sepsis [odds ratio (OR) 1·75, 95% confidence interval (CI) 1·29-2·4], and inpatient mortality (OR 2·15, 95% CI 1·8-2·56) compared to patients without HIV infection. The latter did not attenuate after controlling for complications (OR 2·20, 95% CI 1·83-2·64). HIV infection is associated with increased odds of sepsis and inpatient mortality after acute stroke.
authors.affiliation: Epidemiology Group,Institute of Applied Health Sciences,School of Medicine,Medical Sciences & Nutrition,University of Aberdeen,Aberdeen,UK.
authors.forename: K
authors.initials: K
authors.lastname: Cumming
authors.affiliation: Neurology Division, Department of Medicine,Faculty of Medicine,Khon Kaen University,Khon Kaen,Thailand.
authors.forename: S
authors.initials: S
authors.lastname: Tiamkao
authors.affiliation: Neurology Division, Department of Medicine,Faculty of Medicine,Khon Kaen University,Khon Kaen,Thailand.
authors.forename: K
authors.initials: K
authors.lastname: Kongbunkiat
authors.affiliation: Norwich Medical School,University of East Anglia,Norwich,UK.
authors.forename: A B
authors.initials: AB
authors.lastname: Clark
authors.affiliation: Norwich Medical School,University of East Anglia,Norwich,UK.
authors.forename: J H
authors.initials: JH
authors.lastname: Bettencourt-Silva
authors.affiliation: Ambulatory Medicine Division,Department of Medicine,Faculty of Medicine,Khon Kaen University,Khon Kaen,Thailand.
authors.forename: K
authors.initials: K
authors.lastname: Sawanyawisuth
authors.affiliation: Neurology Division, Department of Medicine,Faculty of Medicine,Khon Kaen University,Khon Kaen,Thailand.
authors.forename: N
authors.initials: N
authors.lastname: Kasemsap
authors.affiliation: Cardiovascular Research Group,Keele University,Stoke-on-Trent,UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Mamas
authors.affiliation: Medical Research Council Uganda Virus Research Institute,Research Unit on AIDS,Entebbe,Uganda.
authors.forename: J A
authors.initials: JA
authors.lastname: Seeley
authors.affiliation: Epidemiology Group,Institute of Applied Health Sciences,School of Medicine,Medical Sciences & Nutrition,University of Aberdeen,Aberdeen,UK.
authors.forename: P K
authors.initials: PK
authors.lastname: Myint
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000453:epidemiology; D020521:Stroke / Q000150:complications* / Q000401:mortality*; D016019:Survival Analysis; D013785:Thailand / Q000453:epidemiology
keywords: Complications; HIV; mortality; outcomes; stroke