Clinical Signs and Laboratory Parameters as Predictors of Mortality among Hospitalized Human Immunodeficiency Virus-Infected Adult Patients at Tertiary Hospital in Surabaya

Authors

  • Rentha Monica Simamora Department of Internal Medicine, Faculty of Medicine, Airlangga University, Soetomo General Teaching Hospital, Surabaya, Indonesia; Department of Internal Medicine, Dr. Kanudjoso Djatiwibowo General Hospital, Balikpapan, Indonesia https://orcid.org/0000-0002-9113-6928
  • Muhammad Vitanata Arfijanto Department of Internal Medicine, Faculty of Medicine, Airlangga University, Soetomo General Teaching Hospital, Surabaya, Indonesia
  • Musofa Rusli Department of Internal Medicine, Faculty of Medicine, Airlangga University, Soetomo General Teaching Hospital, Surabaya, Indonesia
  • Budi Utomo Department of Public Health and Preventive Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia https://orcid.org/0000-0001-6060-9190
  • Cennikon Pakpahan Department of Biomedical Sciences, Andrology Study Program, Faculty of Medicine, Airlangga University, Surabaya, Indonesia https://orcid.org/0000-0003-0157-1131
  • Mr. Garry Prasetyo Adi https://orcid.org/0000-0002-3878-3317

DOI:

https://doi.org/10.3889/oamjms.2021.6223

Keywords:

Predictors, Morbidity, Mortality, Human Immunodeficiency Virus/AIDS, Clinical sign, Laboratory parameters

Abstract

BACKGROUND: The morbidity and mortality rates due to human immunodeficiency virus (HIV) infection are still high despite various and advanced efforts in the management given for HIV/AIDS patients.

AIM: This study proposed that clinical signs and laboratory parameters could be expected to predict the patient’s mortality.

METHODS: This retrospective study was done by collecting 408 medical records of adult HIV/AIDS inpatients at a tertiary hospital in Surabaya from January 1, 2017, to December 31, 2019. Bivariate analysis using Chi-square test was carried out on nine variables, which were Glasgow Coma Scale (GCS) <15, hypotension, PaO2/FiO2 <400 mmHg, elevated liver enzymes, hemoglobin levels <10 mg/dl, platelet count <150,000/mm3, eGFR <60 ml/min/1.73 m2, albumin levels <3.5 mg/dl, and body mass index (BMI) <18.5 kg/m2. Variables which met the criteria would be included in the multivariate analysis using logistic regression.

RESULTS: Based on bivariate analysis, mortality was found to be significantly associated with GCS <15, hypotension, PaO2/FiO2, elevated liver enzymes, platelet count <100,000 mm3, eGFR <60 ml/1.73kg/m2, albumin levels <3.5 mgdl, and BMI <18.5 kg/m2. However, based on multivariate analysis, there were five variables which were found to be able to independently predict the patients’ mortality, those were GCS <15 (OR 11.625), hypotension (OR 6.062), PaO2/FiO2< 400 mmHg (OR 7.794), eGFR <60 ml/min/1.73 m2 (OR 2.646), and albumin levels <3.5 mg/dl (OR 4.091).

CONCLUSION: GCS <15, hypotension, PaO2/FiO2 <400 mmHg, eGFR <60 ml/1.73g/m2, and albumin levels <3.5 mg/dl were found as the independent risk factors which could predict the hospitalized HIV/AIDS patients’ mortality.

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Author Biography

Mr. Garry Prasetyo Adi

Department of Internal Medicine, Faculty of Medicine – Soetomo General Teaching Hospital, Airlangga University, Surabaya, Indonesia

References

Djoerban Z, Djauzi S. HIV/AIDS di Indonesia in Buku Ajar Ilmu Penyakit Dalam. 6th ed., Vol. 1. Jakarta: Balai Penerbit FKUI; 2015.

Japiassu AM, Amancio RT, Mesquita EC, Medeiros DM, Bernal HB, Nunes EP, et al. Sepsis is a major determinant of outcome in critically ill HIV/AIDS patients. Crit Care. 2010;14(4):R152. https://doi.org/10.1186/cc9221 PMid:20698966

Redig AJ, Berliner N. Pathogenesis and clinical implications of HIV-related anemia in 2013. Hematol Am Soc Hematol Educ Program. 2013;2013(1):377-81. https://doi.org/10.1182/asheducation-2013.1.377 PMid:24319207

Saleri N, Capone S, Pietra V, Iaco G, Del Punta V, Rizzi M, et al. Outcome and predictive factors of mortality in hospitalized HIVpatients in burkina faso. Infection. 2009;37(2):142-7. https://doi.org/10.1007/s15010-008-7406-7 PMid:19169635

Rubaihayo J, Tumwesigye NM, Konde-lule J, Makumbi F, Nakku EJ, Wamani H, et al. Trends and predictors of mortality among HIV positive patients in the era of highly active antiretroviral therapy in Uganda. Infect Dis Rep. 2015;7(3):66-73. https://doi.org/10.4081/idr.2015.5967 PMid:26500739

Puspitasari E, Yunihastuti E, Rengganis I, Rumende CM. Prediktor mortalitas pasien HIV/AIDS rawat inap. J Pen Dalam Indones. 2016;3(1):22-8. https://doi.org/10.7454/jpdi.v3i1.29

Deshwal R, Arora S. Serum alanine aminotransferase elevations in HIV positive patients on antiretroviral therapy in India. J Assoc Phys India. 2019;67(3):67-70. PMid:31304710

Feldman JG, Burns DN, Stephen J, Bacchetti P, Cohen M, Anastos K, et al. Serum albumin as a predictor of survival in HIV-infected women in the women’s interagency HIV study. AIDS. 2000;14(7):863-70. https://doi.org/10.1097/00002030-200005050-00013 PMid:10839595

Hu W, Jiang H, Chen W, He S, Deng B, Wang W. Malnutrition in hospitalized people living with HIV/AIDS : Evidence from a cross-sectional study from Chengdu, China. Asia Pac J Clin Nutr. 2011;20(4):544-50. PMid:22094839

Ibrahim F, Hamzah L, Jones R. Baseline kidney function as predictor of mortality and kidney disease progression in HIVpositive patients. Am J Kidney Dis. 2012;60(4):539-47. https://doi.org/10.1053/j.ajkd.2012.03.006 PMid:22521282

Dusingize JC, Hoover DR, Shi Q, Mutimura E, Rudakemwa E, Ndacyayisenga V, et al. Association of abnormal liver function parameters with HIV serostatus and CD4 count in antiretroviralnaïve rwandan women. AIDS Res Hum Retroviruses. 2015;31(7):723-30. https://doi.org/10.1089/aid.2014.0170 PMid:25924728

Owiredu WK, Quaye L, Amidu N, Addai-Mensah O. Renal insufficiency in Ghanaian HIV infected patients: Need for dose adjustment. Afr Health Sci. 2013;13(1):101-11. https://doi.org/10.4314/ahs.v13i1.14 PMid:23658575

Mocroft A, Ryom L, Reiss P, Furrer H, Monforte AD, Gatell J, et al. A comparison of estimated glomerular filtration rates using Cockcroft-Gault and the chronic kidney disease epidemiology collaboration estimating equations in HIV infection. HIV Med. 2014;15(3):144-52. https://doi.org/10.1111/hiv.12095 PMid:24118916

Mamidi A, DeSimone JA, Pomerantz RJ. Central nervous system infections in individual with HIV-1 infection. J Neurovirol. 2002;8(3):158-67. https://doi.org/10.1080/13550280290049723 PMid:12053271

Grmec S, Gasparovic V. Comparison of APACHE II, MEES and Glasgow coma scale in patients with nontraumatic coma for prediction of mortality. Crit Care. 2000;5(1):19-23. https://doi.org/10.1186/cc973 PMid:11178221

Lee Y, Wang J, Sun H, Chen Y. Comparisons of clinical features and mortality of cryptococcal meningitis between patients with and without human immunodeficiency virus infection. J Microbiol Immunol Infect 2011;44(5):338-45. https://doi.org/10.1016/j.jmii.2010.08.011 PMid:21524972

Pecego AC. Amancio RT, Ribeiro C, Mesquita EC, Medeiros DM, Cerbino J, et al. Six-month survival of critically ill patients with HIV--related disease and tuberculosis: A retrospective study. BMC Infect Dis. 2016;6:270. https://doi.org/10.1186/s12879-016-1644-6

Cribbs SK, Crothers K, Morris A. Pathogenesis of HIVrelated lung disease: Immunity, infection, and inflammation. Physiol Rev. 2020;100(2):603-32. https://doi.org/10.1152/physrev.00039.2018 PMid:31600121

Chiliza N, Du Toit M, Wasserman S. Outcomes of HIV-associated pneumocystis pneumonia at a South African referral hospital. PLoS One. 2018;13(8):e0201733. https://doi.org/10.1371/journal.pone.0201733 PMid:30071089

Wu L, Zhang S, Wang Y, Hao Y, Wang F, Gao G, et al. A model to predict in-hospital mortality in HIV/AIDS patients with pneumocystis pneumonia in China: The clinical practice in real world. Biomed Res Int 2019;2019:6057028. https://doi.org/10.1155/2019/6057028 PMid:30906778

Ho JE, Hsue PY. Cardiovascular manifestations of HIV infection. Heart. 2009;95(14):1193-202. https://doi.org/10.1136/hrt.2008.161463 PMid:19564432

Moroni M, Antinori S. HIV and direct damage of organs: Disease spectrum before and during the highly active antiretroviral therapy era. AIDS. 2003;17(1):S51-64. https://doi.org/10.1097/00002030-200304001-00008 PMid:12870531

Ntusi NA. HIV and myocarditis. Curr Opin HIV AIDS. 2017;12(6):561-5. https://doi.org/10.1097/coh.0000000000000416 PMid:28832366

Cheitlin MD. In: Basow DS, editor. Cardiac Involvement in HIVinfected Patients. 2nd ed. Waltham, MA: UptoDate; 2010.

Bloomfield GS, Hogan JW, Keter A, Holland TL, Sang E, Kimaiyo S, et al. Blood pressure level impacts risk of death among HIV seropositive adults in Kenya: A retrospective analysis of electronic health records. BMC Infect Dis. 2014;14:284. https://doi.org/10.1186/1471-2334-14-284 PMid:24886474

Sun C, Wen Y, Liu S, Cui W, Zhou Y, Deng, B, et al. Prevalence of ginjal impairment among HIV positive patients hospitalized in the first hospital of China medical university. Int J Clin Exp Med. 2018;11(8):8622-862.

Wyatt CM. Kidney disease and HIV infection. Top Antivir Med. 2017;25(1):13-6. PMid:28402929

Wyatt CM, Klotman PE, Bronfman S, D’Agati VD. HIV-associated nephropathy: Clinical presentation, pathology, and epidemiology in the era of antiretroviral therapy. Semin Nephrol. 2008;28(6):513-22. https://doi.org/10.1016/j.semnephrol.2008.08.005 PMid:19013322

Munthner P, Hamm L, Kusek JW, Chen J, Whelton PK, He J. The prevalence of nontraditional risk factors for coronary heart disease in patients with chronic kidney disease. Ann Intern Med. 2004;140(1):9-17. https://doi.org/10.7326/0003-4819-140-1-200401060-00006 PMid:14706967

George E, Lucas GM, Nadkarni GN, Fine DM, Moore R, Atta MG. Kidney function and the risk of cardiovascular events in HIV-1 infected patients. AIDS. 2010;24(3):387-94. https://doi.org/10.1097/qad.0b013e3283359253 PMid:20019575

Sudfeld CR, Isanaka S, Aboud S, Mugusi FM, Wang M, Chalamilla GE, et al. Association of serum albumin concentration with mortality, morbidity, CD4 T-cell reconstitution among tanzanians initiatin antiretroviral therapy. J Infect Dis. 2013;207(9):1370-8. PMid:23319741

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Published

2021-06-25

How to Cite

1.
Monica Simamora R, Arfijanto MV, Rusli M, Utomo B, Pakpahan C, Adi GP. Clinical Signs and Laboratory Parameters as Predictors of Mortality among Hospitalized Human Immunodeficiency Virus-Infected Adult Patients at Tertiary Hospital in Surabaya. Open Access Maced J Med Sci [Internet]. 2021 Jun. 25 [cited 2021 Sep. 20];9(B):497-502. Available from: https://oamjms.eu/index.php/mjms/article/view/6223

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Infective Diseases

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