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Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study.

Søgaard OS, Lohse N, Gerstoft J, Kronborg G, Østergaard L, Pedersen C, Pedersen G, Sørensen HT, Obel N - PLoS ONE (2009)

Bottom Line: The first hospitalization for pneumonia among HIV-infected individuals was associated with elevated risk of death up to more than a year later.Use of HAART decreased the risk, independent of current CD4+ cell count.Prognosis following pneumonia improved over calendar time.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark. olesoega@rm.dk

ABSTRACT

Background: HIV-infected persons are at increased risk of pneumonia, even with highly active antiretroviral treatment (HAART). We examined the impact of pneumonia on mortality and identified prognostic factors for death among HIV-infected.

Methodology/principal findings: In a nationwide, population-based cohort of individuals with HIV, we included persons hospitalized with pneumonia from the Danish National Hospital Registry and obtained mortality data from the Danish Civil Registration System. Comparing individuals with and without pneumonia, we used Poisson regression to estimate relative mortality and logistic regression to examine prognostic factors for death following pneumonia. From January 1, 1995, to July 1, 2008, we observed 699 episodes of first hospitalization for pneumonia among 4,352 HIV patients. Ninety-day mortality after pneumonia decreased from 22.4% (95% confidence interval [CI]: 16.5%-28.9%) in 1995-1996 to 8.4% (95% CI: 6.1%-11.6%) in 2000-2008. Mortality remained elevated for more than a year after hospitalization for pneumonia: adjusted mortality rate ratio 5.38 (95% CI: 4.27-6.78), 1.80 (95% CI: 1.36-2.37), and 1.62 (95% CI: 1.32-2.00) for days 0-90, 91-365, and 366+, respectively. The following variables predicted mortality within 90 days following hospitalization for pneumonia (adjusted Odds Ratios): male sex (3.77, 95% CI: 1.37-10.4), Charlson Comorbidity Index score > or = 2 (3.86, 95% CI: 2.19-6.78); no current HAART (3.58, 95% CI: 1.83-6.99); history of AIDS (2.46, 95% CI: 1.40-4.32); age per 10 year increase (1.43, 95% CI: 1.11-1.85); and CD4+ cell count < or = 200 (2.52, 95% CI: 1.37-4.65).

Conclusions/significance: The first hospitalization for pneumonia among HIV-infected individuals was associated with elevated risk of death up to more than a year later. Use of HAART decreased the risk, independent of current CD4+ cell count. Prognosis following pneumonia improved over calendar time.

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Mortality after first hospitalization for pneumonia among persons with HIV by time period.
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pone-0007022-g001: Mortality after first hospitalization for pneumonia among persons with HIV by time period.

Mentions: Overall 30-day risk of death after first hospitalization for pneumonia was 6.4% (95% CI: 4.8%–8.5%) (see Figure 1). It was 7.9% (95% CI: 4.6%–13.5%) in 1995–1996, 7.6% (95% CI: 4.1%–13.6%) in 1997–1999, and 5.5% (95% CI: 3.7%–8.2%) in 2000–2008. Overall 90-day risk of death was 12.0% (95% CI: 9.8%–14.7%), decreasing from 22.4% (95% CI: 16.5%–28.9%) in 1995–1996 to 11.4% (95% CI: 7.0%–18.1%) in 1997–1999, and to 8.4% (95% CI: 6.1%–11.6%) in 2000–2008.


Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study.

Søgaard OS, Lohse N, Gerstoft J, Kronborg G, Østergaard L, Pedersen C, Pedersen G, Sørensen HT, Obel N - PLoS ONE (2009)

Mortality after first hospitalization for pneumonia among persons with HIV by time period.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2737147&req=5

pone-0007022-g001: Mortality after first hospitalization for pneumonia among persons with HIV by time period.
Mentions: Overall 30-day risk of death after first hospitalization for pneumonia was 6.4% (95% CI: 4.8%–8.5%) (see Figure 1). It was 7.9% (95% CI: 4.6%–13.5%) in 1995–1996, 7.6% (95% CI: 4.1%–13.6%) in 1997–1999, and 5.5% (95% CI: 3.7%–8.2%) in 2000–2008. Overall 90-day risk of death was 12.0% (95% CI: 9.8%–14.7%), decreasing from 22.4% (95% CI: 16.5%–28.9%) in 1995–1996 to 11.4% (95% CI: 7.0%–18.1%) in 1997–1999, and to 8.4% (95% CI: 6.1%–11.6%) in 2000–2008.

Bottom Line: The first hospitalization for pneumonia among HIV-infected individuals was associated with elevated risk of death up to more than a year later.Use of HAART decreased the risk, independent of current CD4+ cell count.Prognosis following pneumonia improved over calendar time.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark. olesoega@rm.dk

ABSTRACT

Background: HIV-infected persons are at increased risk of pneumonia, even with highly active antiretroviral treatment (HAART). We examined the impact of pneumonia on mortality and identified prognostic factors for death among HIV-infected.

Methodology/principal findings: In a nationwide, population-based cohort of individuals with HIV, we included persons hospitalized with pneumonia from the Danish National Hospital Registry and obtained mortality data from the Danish Civil Registration System. Comparing individuals with and without pneumonia, we used Poisson regression to estimate relative mortality and logistic regression to examine prognostic factors for death following pneumonia. From January 1, 1995, to July 1, 2008, we observed 699 episodes of first hospitalization for pneumonia among 4,352 HIV patients. Ninety-day mortality after pneumonia decreased from 22.4% (95% confidence interval [CI]: 16.5%-28.9%) in 1995-1996 to 8.4% (95% CI: 6.1%-11.6%) in 2000-2008. Mortality remained elevated for more than a year after hospitalization for pneumonia: adjusted mortality rate ratio 5.38 (95% CI: 4.27-6.78), 1.80 (95% CI: 1.36-2.37), and 1.62 (95% CI: 1.32-2.00) for days 0-90, 91-365, and 366+, respectively. The following variables predicted mortality within 90 days following hospitalization for pneumonia (adjusted Odds Ratios): male sex (3.77, 95% CI: 1.37-10.4), Charlson Comorbidity Index score > or = 2 (3.86, 95% CI: 2.19-6.78); no current HAART (3.58, 95% CI: 1.83-6.99); history of AIDS (2.46, 95% CI: 1.40-4.32); age per 10 year increase (1.43, 95% CI: 1.11-1.85); and CD4+ cell count < or = 200 (2.52, 95% CI: 1.37-4.65).

Conclusions/significance: The first hospitalization for pneumonia among HIV-infected individuals was associated with elevated risk of death up to more than a year later. Use of HAART decreased the risk, independent of current CD4+ cell count. Prognosis following pneumonia improved over calendar time.

Show MeSH
Related in: MedlinePlus