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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
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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: worodria@yahoo.com).

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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received August 04, 2017

Accepted August 21, 2018

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