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Trauma patients with human immunodeficiency virus (HIV): a propensity matched analysis. Eur J Trauma Emerg Surg 2020; 48:449-454. [PMID: 32448942 PMCID: PMC7246034 DOI: 10.1007/s00068-020-01402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/16/2020] [Indexed: 11/24/2022]
Abstract
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 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 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 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.
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The Effect of Human-Immunodeficiency Virus Status on Outcomes in Penetrating Abdominal Trauma: An Interim Analysis. World J Surg 2018; 42:2412-2420. [PMID: 29387958 DOI: 10.1007/s00268-018-4502-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether the outcomes of hemodynamically stable patients undergoing exploratory laparotomy for penetrating abdominal trauma differed as a result of their HIV status. METHODS This was an observational, prospective study from February 2016 to May 2017. All hemodynamically stable patients with penetrating abdominal trauma requiring a laparotomy were included. The mechanism of injury, the HIV status, age, the penetrating abdominal trauma index (PATI), and the revised trauma score (RTS) were entered into a binary logistic regression model. Outcome parameters were in-hospital death, morbidity, admission to intensive care unit (ICU), relaparotomy within 30 days, and length of stay longer than 30 days. RESULTS A total of 209 patients, 94% male, with a mean age of 29 ± 10 years were analysed. Twenty-eight patients (13%) were HIV positive. The two groups were comparable. Ten (4.8%) laparotomies were negative. There were two (0.96%) deaths, both in the HIV negative group. The complication rate was 34% (n = 72). Twenty-nine patients (14%) were admitted to the ICU. A higher PATI, older age, and a lower RTS were significant risk factors for ICU admission. After 30 days, 12 patients (5.7%) were still in hospital. Twenty-four patients (11%) underwent a second laparotomy. The PATI score was the single independent predictor for complications, relaparotomy, and hospital stay longer than 30 days. CONCLUSIONS Preliminary results reveal that HIV status does not influence outcomes in patients with penetrating abdominal trauma.
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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 2018; 165:444-449. [PMID: 30327188 DOI: 10.1016/j.surg.2018.07.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is conflicting evidence regarding the impact of human immunodeficiency virus serostatus on trauma outcomes in low-resource settings. This study sought to evaluate the impact of human immunodeficiency virus serostatus on mortality outcomes for Rwandan patients presenting after trauma. METHODS This retrospective review of the University of Rwanda trauma registry captured all adult trauma patients with known human immunodeficiency virus status presenting between March 2011 and July 2015. Confirmed human immunodeficiency virus-positive cases were matched 1:2 with known human immunodeficiency virus-negative controls using a modified Kampala Trauma Score, sex, and district of residence or primary hospital. All-cause mortality was compared using multivariable logistic regression. RESULTS In total, 11,280 patients were recorded prospectively in the registry (169 human immunodeficiency virus positive; 334 human immunodeficiency virus negative matches). There was no difference in delay of hospital presentation or time until operation (P = .50 and P = .57, respectively). Less than 30% of all patients underwent operation during admission (n = 133), and the rate of operative intervention was independent of human immunodeficiency virus serostatus (P = .946). There was no association between development of any complication and human immunodeficiency virus status (P = .837). The overall mortality rate was 8.9% and 3.3% for human immunodeficiency virus-positive and human immunodeficiency virus-negative patients, respectively (P = .010). Human immunodeficiency virus positivity was associated with increased 30-day mortality when controlling for potential confounders (P = .016; odds ratio 3.60, 95% confidence interval: 1.27-10.2, C statistic 0.88). CONCLUSION Both human immunodeficiency virus and trauma pose substantial public health threats in sub-Saharan Africa. Known human immunodeficiency virus seropositivity in Rwandan trauma patients is associated with early mortality. Further investigation regarding testing, treatment, and outcomes in human immunodeficiency virus-positive trauma patients is warranted and provides an opportunity for leveraging human immunodeficiency virus global health efforts in trauma outcomes assessment.
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Affiliation(s)
- Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - Jean Claude Byiringiro
- Division of Clinical Education and Research, University Teaching Hospital of Kigali, Kigali, Rwanda; College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Robin T Petroze
- Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Menelas Nkeshimana
- Department of Accident and Emergency, University Teaching Hospital of Kigali, Rwanda
| | - Fidele Byiringiro
- Department of Surgery, University Teaching Hospital of Kigali, Rwanda
| | - James F Calland
- Department of Surgery, University of Virginia, Charlottesville, VA
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Mongardon N, Geri G, Deye N, Sonneville R, Boissier F, Perbet S, Camous L, Lemiale V, Thirion M, Mathonnet A, Argaud L, Bodson L, Gaudry S, Kimmoun A, Legriel S, Lerolle N, Luis D, Luyt CE, Mayaux J, Guidet B, Pène F, Mira JP, Cariou A. Etiologies, clinical features and outcome of cardiac arrest in HIV-infected patients. Int J Cardiol 2015; 201:302-7. [PMID: 26301665 DOI: 10.1016/j.ijcard.2015.08.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/29/2015] [Accepted: 08/01/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Compared to many other cardiovascular diseases, there is a paucity of data on the characteristics of successfully resuscitated cardiac arrest (CA) patients with human immunodeficiency virus (HIV) infection. We investigated causes, clinical features and outcome of these patients, and assessed the specific burden of HIV on outcome. METHODS Retrospective analysis of HIV-infected patients admitted to 20 French ICUs for successfully resuscitated CA (2000-2012). Characteristics and outcome of HIV-infected patients were compared to those of a large cohort of HIV-uninfected patients admitted after CA in the Cochin Hospital ICU during the same period. RESULTS 99 patients were included (median CD4 lymphocyte count 233/mm(3), viral load 43 copies/ml). When compared with the control cohort of 1701 patients, HIV-infected patients were younger, with a predominance of male, a majority of in-hospital CA (52%), and non-shockable initial rhythm (80.8%). CA was mostly related to respiratory cause (n=36, including 23 pneumonia), cardiac cause (n=33, including 16 acute myocardial infarction), neurologic cause (n=8) and toxic cause (n=5). CA was deemed directly related to HIV infection in 18 cases. Seventy-one patients died in the ICU, mostly for care withdrawal after post-anoxic encephalopathy. After propensity score matching, ICU mortality was not significantly affected by HIV infection. Similarly, HIV disease characteristics had no impact on ICU outcome. CONCLUSIONS Etiologies of CA in HIV-infected patients are miscellaneous and mostly not related to HIV infection. Outcome remains bleak but is similar to outcome of HIV-negative patients.
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Affiliation(s)
- Nicolas Mongardon
- Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U970, Sudden Death Expertise Centre, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, France
| | - Nicolas Deye
- Medical Intensive Care Unit, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Romain Sonneville
- Medical Intensive Care Unit, Bichat University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Florence Boissier
- Medical Intensive Care Unit, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; Medical Intensive Care Unit, Georges Pompidou European University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sébastien Perbet
- Intensive Care Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laurent Camous
- Medical Intensive Care Unit, Bicêtre University Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Marina Thirion
- Intensive Care Unit, Victor Dupouy Hospital, Argenteuil, France
| | | | - Laurent Argaud
- Intensive Care Unit, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laurent Bodson
- Intensive Care Unit, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Stéphane Gaudry
- Medical Intensive Care Unit, Louis Mourier University Hospital, Assistance Publique - Hôpitaux de Paris, Colombes, France
| | - Antoine Kimmoun
- Medical Intensive Care Unit, Nancy-Brabois University Hospital, Nancy, France
| | | | - Nicolas Lerolle
- Medical Intensive Care Unit, Angers University Hospital, Angers, France
| | - David Luis
- Intensive Care Unit, Raymond Poincaré University Hospital, Assistance Publique - Hôpitaux de Paris, Garches, France
| | - Charles-Edouard Luyt
- Medical Intensive Care Unit, Pitié-Salpétrière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Julien Mayaux
- Pulmonary Medicine and Medical Intensive Care Unit, Pitié-Salpétrière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Saint-Antoine University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U970, Sudden Death Expertise Centre, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, France.
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Tessier JM, Sirkin M, Wolfe LG, Duane TM. Trauma after transplant: hold the antibiotics please. Surg Infect (Larchmt) 2013; 14:177-80. [PMID: 23448593 DOI: 10.1089/sur.2012.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Despite the increase in transplantation and the prevalence of trauma as a major disease entity, few data exist about transplant patients who suffer trauma. We conducted a study to determine whether transplant patients (TP) have worse outcomes, particularly of infections, than do their non-transplant (NTP) counterparts after trauma. METHODS We performed a retrospective review of trauma patients from 2006 to 2010. All patients who had undergone organ transplantation were included and compared through 1:3 propensity matching with their NTP counterparts. Data for the groups were compared to determine differences in outcomes. RESULTS The review included 17 TP (13 kidney, 2 liver, 1 kidney/liver, and 1 kidney/pancreas) as compared with 51 NTP. The patients were matched for injury severity score (ISS), age, and gender, with most suffering blunt trauma (82.4% [14/17] TP vs. 90% [46/51] NTP, p = 0.5). The groups had similar initial Glasgow Coma Scale (GCS) scores (13.2 ± 4.5 TP vs. 13.9 ± 2.5 NTP, p=0.6), serum lactate concentrations (2.0 ± 1.8 mmol/L TP vs. 2.3 ± 1.5 mmol/L NTP, p=0.39), and base deficits (-1.5 ± 4.0 TP vs. 0.6 ± 3.0 NTP, p=0.21). Comorbidities were more common in the TP than in the NTP group. The groups had similar lengths of stay (days on ventilator: 0.1 ± 0.3 TP vs. 0.4 ± 1.6 NTP, p=0.9; days in ICU: 0.2 ± 0.6 TP vs. 2.4 ± 5.9 NTP, p=0.16; days in hospital: 5.2 ± 6.8 TP vs. 7.5 ± 10.2 NTP, p=0.86), and two deaths occurred in each of the two groups (p=0.26). Overall complications were similar (52.94% [9/17] TP vs. 62.75% [32/51] NTP, p=0.57), and there were only two infections, both in the NTP group (p=1.0). Antibiotics were given to 59% of the TP vs. 39% of the NTP, with an average duration of 8.4 days for the TP vs. 3.9 days for the NTP. CONCLUSION When matched equally for degree of injury, the TP and NTP had similar outcomes. There also appeared to be no differences in infectious complications in the two groups, yet more of the TP had exposure to more days of antibiotics. Similar protocols of antimicrobial therapy should apply to both TP and NTP to avoid the overuse of antimicrobial agents and ensure maintenance of the susceptibility patterns of pathogens.
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Affiliation(s)
- Jeffrey M Tessier
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298, USA
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