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Critical Care  2012 

Sepsis as a major determinant of outcome in critically ill HIV/AIDS patients: don't forget acute kidney injury

DOI: 10.1186/cc11870

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Rodrigo Teixeira Amancio, André Miguel Japiassú and Fernando Augusto BozzaAcute renal failure (ARF) is one of the major determinants of hospital outcome in the critically ill population, and severe sepsis is the main cause of ARF in this setting [5]. Patients with HIV/AIDS show a predisposition to renal dysfunction, as the HIV and antiretroviral drugs can lead to renal tubular dysfunction [6]. Lopes and colleagues [3,4] have reported that ARF is independently associated with hospital mortality of critically ill patients with HIV.We evaluated 88 HIV-positive critically ill patients, seeking the main risk factors for mortality [1]. Severe sepsis was the major factor associated with 28-day and 6-month mortality. CD4 cell count, viral load, and the use of antiretrovirals were not associated with survival. As suggested by Lopes and Jorge, we reanalyzed the data about organ dysfunctions in that cohort, targeting hospital outcome. Nonsurvivors presented higher rates of renal (63% versus 33%, P = 0.01) and hematological (42% versus 16%, P = 0.009) dysfunctions than survivors of HIV/AIDS. We included these organ dysfunctions in a new multivariate analysis; severe sepsis remained the main factor associated with hospital survival (odds ratio (OR) 4.2, 95% confidence interval (CI) 1.2 to 14.2, P = 0.02), and renal (OR 2.6, 95% CI 0.9 to 7.4, P = 0.06) and hematological (OR 2.7, 95% CI 0.9 to 8.5, P = 0.08) dysfunction had borderline results (Table 1). We also reevaluated our current cohort, reaching 139 patients with HIV, and the presence of renal failure was related to poorer prognosis but was not associated with hospital mortality in the multivariate analysis (OR 1.9, 95% CI 0.8 to 4.4, P = 0.15). We agree that renal dysfunction, especially when associated with severe sepsis, can reduce survival among critically ill patients with HIV/AIDS.AKI: acute kidney injury; ARF: acute renal failure; CI: confidence interval; OR: odds ratio.The authors declare that they have no competing

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