Predictors of Pneumonia Severity in HIV-Infected Adults Admitted to an Urban Public Hospital

Abstract

Data on outcomes of community-acquired pneumonia (CAP) in the HIV-infected population are mixed and the perception of worse outcomes in HIV may lead to excess hospitalization. We retrospectively evaluated the utility of the Pneumonia Severity Index, or PORT score, as a prediction rule for mortality in 102 HIV-infected adults hospitalized at an urban public hospital with CAP. Primary outcome was survival at 30 days. Secondary outcomes included survival on discharge, intensive care unit (ICU) admission, length of stay, and readmission within 30 days. The cohort was predominantly male (70%) with a mean age of 45.4 years (standard deviation [SD] -7.4). Mean CD4 cell count was 318 cells per microliter; 40 (39%) had CD4 less than 200 cells per microliter. Forty-three percent were on antiretroviral therapy at the time of admission and 31% on prophylactic antibiotics. Twelve patients had bacteremia on admission, predominantly with Streptococcus pneumoniae. Of the 46 patients with admission sputum cultures, 20 yielded an organism, most commonly Haemophilus influenzae and S. pneumoniae. Overall survival in the cohort was high, 96%. Most patients (81%) had a low PORT risk score (class I-III). PORT score predicted 30-day survival ( p = 0.01) and ICU admission ( p = 0.03), but antiretroviral use did not. In contrast to a prior study, we did not find that CD4 cell count predicted CAP outcome. Lack of stable housing was not associated with worse outcomes. The PORT score may be a valid tool to predict mortality and need for hospital admission in HIV-infected patients with CAP.

Presence of an Alcohol Use Disorder is Associated with Greater Pneumonia Severity in Hospitalized HIV-Infected Patients

“…The pneumonia severity index (PSI) has been extensively validated, including in HIV+ populations with risk groups predictive of pneumonia-related mortality [17–22]. All variables contributing to the PSI were obtained at the time of presentation.…”

CURB-65 and other markers of illness severity in community-acquired pneumonia among HIV-positive patients

“…28 Stemming from different methodologies, there is disagreement in the association between lower CD4 cell counts and worse outcomes, including multilobar consolidation, longer time to clinical stability and increased mortality. Some studies have reported no impact of this marker on CAP outcome, 11,17 whereas others have conversely found a significant impact on mortality, prompting authors to recommend admission of all patients in the <200 cells/mL subgroup. 13,15,29 Taking into account our results, in addition to CURB-65 scores, low CD4 cell counts seem to be independent predictive factors in the severity assessment of HIV-positive patients presenting with CAP.…”

“…6,12,[14][15][16] Research has addressed this topic since the beginning of the HAART era, focusing on the course and outcome of CAP in HIV-positive patients. 5,13,15,[17][18][19] HIV infection is a known risk factor for bacteraemia, 5,19 but apparently not for higher mortality 5,18,20,21 or time to clinical stability. 20,21 Evidence on prediction of severity and resulting guidance on risk stratification and related management remains heterogeneous.…”

“…20,21 Evidence on prediction of severity and resulting guidance on risk stratification and related management remains heterogeneous. 13,15,17,18 In order to assess CAP severity on presentation and consequently guide therapeutic options, several prediction scales based on clinical and laboratorial criteria have been developed, which are nowadays widely used and endorsed by clinical societies worldwide. 3,4,22 The Pneumonia Severity Index (PSI), developed in the USA, uses a total of 20 variables, including clinical background and signs, and venous and arterial blood markers.…”

Community-acquired pneumonia in adult HIV-infected patients: course, treatment, and prevention

“…Такая ситуация объясняется тем, что заболеваемость ВП не так сильно связана с CD4 лимфопенией. В отли чие от вторичных заболеваний, которые, как прави ло, развиваются на поздних стадиях ВИЧ инфек ции, бактериальные пневмонии могут развиться в любой период заболевания и при любом количест ве CD4 лимфоцитов [9][10][11]. Это связано с бóльшей значимостью гуморального иммунитета по сравне нию с клеточным в борьбе с традиционными возбу дителями пневмоний.…”