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Prognostic value of markers identifiable in the emergency department in pneumonia patients infected with the human immunodeficiency virus

Perelló R, Miró O, Camón S, Sánchez M, Miró JM, Marcos MA, Moreno A

√Ārea de Urgencias, Hospital Cl√≠nic, Barcelona, Spain. Grupo de Investigaci√≥n ¬ďUrgencias: Procesos y Patolog√≠as¬Ē, IDIBAPS, Barcelona, Spain. Servicio de Enfermedades Infecciosas, Hospital Cl√≠nic, IDIBAPS, Universidat de Barcelona, Spain. Servicio de Microbiolog√≠a, Hospital Cl√≠nic, Barcelona Centre for International Health Research (CRESIB, Hospital Cl√≠nic-Universitat de Barcelona), Spain.

Objective: To evaluate the predictive value of clinical and analytical markers that can be
assessed in the emergency department (ED) for patients with community-acquired
pneumonia (CAP) who are also infected with the human immunodeficiency virus (HIV).
Patients and methods: Prospective 3-year study including all HIV-infected patients with
CAP of onset more than 24-hours earlier who were admitted to hospital from the ED. We
assessed C-reactive protein (CRP) level, heart rate, systolic blood pressure, PaO2, and the
Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The primary
outcome measures were admission to an intensive care unit (ICU), requirement for
mechanical ventilation, and 30-day mortality. These endpoints were also analyzed in
combination. The predictive power of the variables was assessed by calculating the area
under the receiver operating characteristic curve.
Results: We included 159 patients. The following variables were significant predictors of
ICU admission in the group overall: heart rate, APACHE II score, PaO2, CRP level, and
white blood cell count. The first 3 variables were also significant predictors of prognosis
in the subgroup of patients with pneumococcal pneumonia. The following variables
predicted requirement for mechanical ventilation in the series overall: APACHE II score,
PaO2, CRP level, hepatitis C virus infection, and age. The first 2 variables plus white
blood cell count were significant predictors in patients with pneumococcal pneumonia.
The following variables were predictors of death within 30 days: APACHE II score, PaO2,
and hepatitis C virus infection. None were significant prognostic predictors in the
patients with pneumococcal pneumonia.
Conclusion: Hypoxemia, tachypnea, and APACHE II score were the most useful
predictors which can be identified in the ED of poor prognosis in HIV-infected patients
who are admited in hospital with CAP.

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