Trauma patients with human immunodeficiency virus (HIV): a propensity matched analysis.
AIDS
Complications
HIV
Mortality
Outcomes
Trauma
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
01
04
2020
accepted:
16
05
2020
pubmed:
26
5
2020
medline:
11
2
2022
entrez:
26
5
2020
Statut:
ppublish
Résumé
Given the growing number of people worldwide living with human immunodeficiency virus (HIV), a larger subset of these patients are now susceptible to sustaining a traumatic injury. However, the impact of HIV on outcomes in trauma with modern antiretroviral treatment remains unclear. We hypothesized mortality and rates of infectious and inflammatory complications would be higher in HIV positive (HIV+) trauma patients. The Trauma Quality Improvement Program was queried to identify trauma patients ≥ 18 years of age with HIV. Due to the imbalance between HIV+ and HIV negative (HIV-) trauma patients, a 1:2 propensity-matched model was utilized. Matched variables included age, injury severity score, mechanism of injury, systolic blood pressure, pulse rate, Glasgow Coma Scale score, and patient comorbidities. 84 HIV+ patients were matched to 168 HIV- patients. Compared to HIV- patients, HIV+ patients had no significant differences in mortality rate (9.5% vs. 4.8%, p = 0.144) or infectious complications, including pneumonia (6.0% vs. 4.2%, p = 0.530), urinary tract infection (1.2% vs. 1.2%, p = 1.000), or severe sepsis (1.2% vs. 0.0%, p = 0.156). However, higher rates of acute respiratory distress syndrome (ARDS) (9.5% vs. 0.6%, p < 0.001) and acute kidney injury (AKI) (4.8% vs. 0.0%, p = 0.004) were observed. HIV+ trauma patients are not at higher risk of mortality or infectious complications, likely due to the advent and prevalence of combination antiretroviral therapy. However, HIV positivity appears to increase the risk of AKI and ARDS in trauma patients. Further research is needed to confirm this finding to elucidate the etiology underlying this association.
Sections du résumé
BACKGROUND
BACKGROUND
Given the growing number of people worldwide living with human immunodeficiency virus (HIV), a larger subset of these patients are now susceptible to sustaining a traumatic injury. However, the impact of HIV on outcomes in trauma with modern antiretroviral treatment remains unclear. We hypothesized mortality and rates of infectious and inflammatory complications would be higher in HIV positive (HIV+) trauma patients.
METHODS
METHODS
The Trauma Quality Improvement Program was queried to identify trauma patients ≥ 18 years of age with HIV. Due to the imbalance between HIV+ and HIV negative (HIV-) trauma patients, a 1:2 propensity-matched model was utilized. Matched variables included age, injury severity score, mechanism of injury, systolic blood pressure, pulse rate, Glasgow Coma Scale score, and patient comorbidities.
RESULTS
RESULTS
84 HIV+ patients were matched to 168 HIV- patients. Compared to HIV- patients, HIV+ patients had no significant differences in mortality rate (9.5% vs. 4.8%, p = 0.144) or infectious complications, including pneumonia (6.0% vs. 4.2%, p = 0.530), urinary tract infection (1.2% vs. 1.2%, p = 1.000), or severe sepsis (1.2% vs. 0.0%, p = 0.156). However, higher rates of acute respiratory distress syndrome (ARDS) (9.5% vs. 0.6%, p < 0.001) and acute kidney injury (AKI) (4.8% vs. 0.0%, p = 0.004) were observed.
CONCLUSION
CONCLUSIONS
HIV+ trauma patients are not at higher risk of mortality or infectious complications, likely due to the advent and prevalence of combination antiretroviral therapy. However, HIV positivity appears to increase the risk of AKI and ARDS in trauma patients. Further research is needed to confirm this finding to elucidate the etiology underlying this association.
Identifiants
pubmed: 32448942
doi: 10.1007/s00068-020-01402-4
pii: 10.1007/s00068-020-01402-4
pmc: PMC7246034
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
449-454Informations de copyright
© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
UNAIDS Data 2018. Joint United Nations Programme on HIV/AIDS (UNAIDS). https://www.unaids.org/sites/default/files/media_asset/unaids-data-2018_en.pdf . Published July 2018. Accessed 22 Jan 2019.
CDC. Estimated HIV incidence and prevalence in the United States, 2010–2015. HIV Surveillance Supplemental Report. 2018;23(1). https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html . Published March 2018. Accessed 22 Jan 2019.
WHO HIV Update 2017. World Health Organization (WHO). https://www.who.int/hiv/data/2017_global_summary_web_v11.pptx . Accessed 3 Jun 2019.
Martin AN, Byiringiro JC, Petroze RT, Nkeshimana M, Byiringiro F, Calland JF. Assessing the impact of HIV status on injury outcomes: a multicenter study of trauma patients in Rwanda. Surgery. 2019;165(2):444–9.
doi: 10.1016/j.surg.2018.07.037
Stawicki SP, Hoff WS, Hoey BA, Grossman MD, Scoll B, Reed JF 3rd. Human immunodeficiency virus infection in trauma patients: where do we stand? J Trauma. 2005;58(1):88–93.
doi: 10.1097/01.TA.0000124279.08072.F5
Duane TM, Sekel S, Wolfe LG, Malhotra AK, Aboutanos MB, Ivatury RR. Does HIV influence outcomes after trauma? J Trauma. 2008;65(1):63–5.
pubmed: 18580533
pmcid: 18580533
Morrison CA, Wyatt MM, Carrick MM. Effects of human immunodeficiency virus status on trauma outcome: a review of the national trauma database. Surg Infect (Larchmt). 2010;11(1):41–7.
doi: 10.1089/sur.2008.050
Patel MS, Malinoski DJ, Nguyen XM, Hoyt DB. The impact of select chronic diseases on outcomes after trauma: a study from the National Trauma Data Bank. J Am Coll Surg. 2011;212(1):96–104.
doi: 10.1016/j.jamcollsurg.2010.09.028
McPherson D, Neuhaus V, Dhar R, Edu S, Nicol AJ, Navasaria PH. The effect of human-immunodeficiency virus status on outcomes in penetrating abdominal trauma: an interim analysis. World J Surg. 2018;42:2412–20.
doi: 10.1007/s00268-018-4502-4
Marcus JL, Chao CR, Leyden WA, et al. Narrowing the gap in life expectancy between HIV-infected and HIV-uninfected individuals with access to care. J Acquir Immune Defic Syndr. 2016;73(1):39–46.
doi: 10.1097/QAI.0000000000001014
Wandeler G, Johnson LF, Egger M. Trends in life expectancy of HIV-positive adults on antiretroviral therapy across the globe: comparisons with general population. Curr Opin HIV AIDS. 2016;11(5):492–500.
doi: 10.1097/COH.0000000000000298
Teeraananchai S, Kerr SJ, Amin J, et al. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV Med. 2017;18(4):256–66.
doi: 10.1111/hiv.12421
Newgard CD, Fileds JJ, Wu L, et al. Methodology and analytic rationale for the American College of Surgeons Trauma Quality Improvement Program. J Am Coll Surg. 2013;216(1):147–57.
doi: 10.1016/j.jamcollsurg.2012.08.017
Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2011;10(2):150–61.
doi: 10.1002/pst.433
Barré-Sinoussi F, Ross AL, Delfraissy JF. Past, present, and future: 30 years of HIV research. Nat Rev Microbiol. 2013;11:877–83.
doi: 10.1038/nrmicro3132
CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2016. HIV Surveillance Supplemental Report 2018;23(No. 4). https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html . Published June 2018. Accessed 3 Jul 2019.
CDC. Vital signs: HIV prevention through care and treatment–United States. MMWR. 2011;60(47):1618–23.
Rosenberg AZ, Naicker S, Winkler CA, Kopp JB. HIV-associated nephropathies: epidemiology, pathology, mechanisms and treatment. Nat. Rev. Nephrol. 2015;11:150–160.
doi: 10.1038/nrneph.2015.9
Lenz A, Franklin GA, Cheadle WG. Systemic inflammation after trauma. Injury. 2007;38 (12):1336-45.
doi: 10.1016/j.injury.2007.10.003
Yaseen MM, Abuharfeil NM, Yaseen MM, Shabsoug BM. The role of polymorphonuclear neutrophils during HIV-1 infection. Arch Virol. 2018;163(1):1-21.
doi: 10.1007/s00705-017-3569-9
Pierrakos C, Karanikolas M, Scolletta S, Karamouzos V, Velissaris D. Acute respiratory distress syndrome: pathophysiology and therapeutic options. J Clin Med Res. 2012;4(1):7-16.
pubmed: 22383921
pmcid: 22383921
Roe J, Campbell LJ, Ibrahim F, et al. HIV care and the incidence of acute renal failure. Clin Infect Dis. 2008;47:242–249.
doi: 10.1086/589296
Yombi JC, Pozniak A, Boffito M, Jones R, Khoo S, Levy J, et al. Antiretrovirals and the kidney in current clinical practice: renal pharmacokinetics, alterations of renal function and renal toxicity. AIDS 2014; 28:621–632.
doi: 10.1097/QAD.0000000000000103
Mocroft A, Kirk O, Reiss P, De Wit S, Sedlacek D, Beniowski M, et al. Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. AIDS 2010; 24:1667–1678.
doi: 10.1097/QAD.0b013e328339fe53
Ryom L, Mocroft A, Kirk O, Worm SW, Kamara DA, Reiss P, et al. Association between antiretroviral exposure and renal impairment among HIV-positive persons with normal baseline renal function: the D:A:D study. J Infect Dis 2013; 207:1359– 1369.
doi: 10.1093/infdis/jit043
Campos P, Ortiz A, Soto K. HIV and kidney diseases: 35 years of history and consequences. Clin Kidney J. 2016;9(6):772–781.
doi: 10.1093/ckj/sfw104