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Predictors of Mortality Among Hospitalized Patients With Lower Respiratory Tract Infections in a High HIV Burden Setting

Worodria, William, MBChB, MMed, PhD*,†,‡; Chang, Emily, BSc§; Andama, Alfred, DMLT, BBLT, MLT†,‡; Sanyu, Ingvar, BScN, MPH; Byanyima, Patrick, DMLT, BIS; Musisi, Emmanuel, BBLT, MSc; Kaswabuli, Sylvia, BST/B; Zawedde, Josephine, BScN, BBLT, BSc(IT); Ayakaka, Irene, MBChB, MPH; Sessolo, Abdul, MBChB, MSc; Lalitha, Rejani, MBChB, MMed†,‡; Davis, John Lucian, MD, MAS║,¶; Huang, Laurence, MD§

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15, 2018 - Volume 79 - Issue 5 - p 624–630
doi: 10.1097/QAI.0000000000001855
Clinical Science

Introduction: Lower respiratory tract infections (LRTIs) are a leading cause of mortality in sub-Saharan Africa. Triaging identifies patients at high risk of death, but laboratory tests proposed for use in severity-of-illness scores are not readily available, limiting their clinical use. Our objective was to determine whether baseline characteristics in hospitalized participants with LRTI predicted increased risk of death.

Methods: This was a secondary analysis from the Mulago Inpatient Non-invasive Diagnosis-International HIV-associated Opportunistic Pneumonias (MIND-IHOP) cohort of adults hospitalized with LRTI who underwent standardized investigations and treatment. The primary outcome was all-cause mortality at 2 months. Predictors of mortality were determined using multiple logistic regression.

Results: Of 1887 hospitalized participants with LRTI, 372 (19.7%) died. The median participant age was 34.3 years (interquartile range, 28.0–43.3 years), 978 (51.8%) were men, and 1192 (63.2%) were HIV-positive with median CD4 counts of 81 cells/µL (interquartile range, 21–226 cells/µL). Seven hundred eleven (37.7%) participants had a microbiologically confirmed diagnosis. Temperature <35.5°C [adjusted odds ratio (aOR) = 1.77, 95% confidence intervals (CI): 1.20 to 2.60; P = 0.004], heart rate >120/min (aOR = 1.82, 95% CI: 1.37 to 2.43; P < 0.0001), oxygen saturation <90% (aOR = 2.74, 95% CI: 1.97 to 3.81; P < 0.0001), being bed-bound (aOR = 1.88, 95% CI: 1.47 to 2.41; P < 0.0001), and being HIV-positive (aOR = 1.49, 95% CI: 1.14 to 1.94; P = 0.003) were independently associated with mortality at 2 months.

Conclusions: Having temperature <35.5°C, heart rate >120/min, hypoxia, being HIV-positive, and bed-bound independently predicts mortality in participants hospitalized with LRTI. These readily available characteristics could be used to triage patients with LRTI in low-income settings. Providing adequate oxygen, adequate intravenous fluids, and early antiretroviral therapy (in people living with HIV/AIDS) may be life-saving in hospitalized patients with LRTI.

*Department of Medicine, Mulago Hospital, Kampala, Uganda;

Department of Medicine, Makerere College of Health Sciences, Kampala, Uganda;

Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda;

§Department of Medicine, University of California San Francisco, San Francisco, CA;

Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT; and

Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT.

Correspondence to: William Worodria, MBChB, MMed, PhD, Department of Medicine, Mulago Hospital, P.O. Box 7051, Kampala, Uganda (e-mail:

Supported by NIH K24 HL087713 (L.H.), NIH R01 HL090335 (L.H.), NIH R01 HL128156 (L.H.).

The authors have no funding or conflicts of interest to disclose.

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Received August 04, 2017

Accepted August 21, 2018

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