Publication
CURB-65 and other markers of illness severity in community-acquired pneumonia among HIV-positive patients
| dc.contributor.author | Almeida, André | |
| dc.contributor.author | Almeida, Ana Rita | |
| dc.contributor.author | Branco, Sara Castelo | |
| dc.contributor.author | Vesza, Zsófia | |
| dc.contributor.author | Pereira, Rui | |
| dc.date.accessioned | 2016-10-28T19:10:39Z | |
| dc.date.available | 2016-10-28T19:10:39Z | |
| dc.date.issued | 2015 | |
| dc.description.abstract | Introduction: As the relative burden of community-acquired bacterial pneumonia among HIV-positive patients increases, adequate prediction of case severity on presentation is crucial. We sought to determine what characteristics measurable on presentation are predictive of worse outcomes. Methods: We studied all admissions for community-acquired bacterial pneumonia over 1 year at a tertiary centre. Patient demographics, comorbidities, HIV-specific markers and CURB-65 scores on Emergency Department presentation were reviewed. Outcomes of interest included mortality, bacteraemia, intensive care unit admission and orotracheal intubation. Results: A total of 396 patients were included, 49 HIV positive and 347 HIV negative. Mean CURB-65 score was 1.3 for HIV-positive and 2.2 for HIV-negative patients (p<0.0001), its predictive value for mortality being maintained in both groups (p¼0.03 and p<0.001, respectively). Adjusting for CURB-65 scores, HIV infection by itself was only associated with bacteraemia (adjusted odds ratio 7.1 CI 95% [2.6–19.5]). Patients with<200 CD4 cells/mL presented similar CURB- 65 adjusted mortality (adjusted odds ratio 1.7 CI 95% [0.2–15.2]), but higher risk of intensive care unit admission (adjusted odds ratio 5.7 CI 95% [1.5–22.0]) and orotracheal intubation (adjusted odds ratio 9.1 CI 95% [2.2–37.1]), compared to HIV-negative patients. These two associations were not observed in the>200 CD4 cells/mL subgroup (adjusted odds ratio 2.2 CI 95% [0.7–7.6] and adjusted odds ratio 0.8 CI 95% [0.1–6.5] respectively). Antiretroviral therapy and viral load suppression were not associated with different outcomes (p>0.05). Conclusions: High CURB-65 scores and CD4 counts<200 cells/mL were both associated with worse outcomes. Severity assessment scales and CD4 counts may both be helpful in predicting severity in HIV-positive patients presenting with community-acquired bacterial pneumonia. | pt_PT |
| dc.identifier.citation | International Journal of STD and AIDS, 27, 998-1004. Doi: 10.1177/0956462415605232. | pt_PT |
| dc.identifier.doi | 10.1177/0956462415605232 | pt_PT |
| dc.identifier.issn | 0956-4624 | |
| dc.identifier.uri | http://hdl.handle.net/10400.12/5016 | |
| dc.language.iso | eng | pt_PT |
| dc.peerreviewed | yes | pt_PT |
| dc.publisher | SAGE Publications | pt_PT |
| dc.relation.publisherversion | http://std.sagepub.com/content/27/11/998 | pt_PT |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | pt_PT |
| dc.subject | HIV | pt_PT |
| dc.subject | Pneumonia | pt_PT |
| dc.subject | Clinical prediction rule | pt_PT |
| dc.title | CURB-65 and other markers of illness severity in community-acquired pneumonia among HIV-positive patients | pt_PT |
| dc.type | journal article | |
| dspace.entity.type | Publication | |
| oaire.citation.conferencePlace | United Kingdom | pt_PT |
| oaire.citation.endPage | 1004 | pt_PT |
| oaire.citation.issue | 11 | pt_PT |
| oaire.citation.startPage | 998 | pt_PT |
| oaire.citation.title | International Journal of STD and AIDS | pt_PT |
| oaire.citation.volume | 27 | pt_PT |
| rcaap.rights | restrictedAccess | pt_PT |
| rcaap.type | article | pt_PT |