Characteristics and prognostic factors of HIV-positive adults in the emergency department of a university hospital in South Korea, 2013-2022

초록

An estimated 39 million individuals globally were living with human immunodeficiency virus (HIV) at the end of 2022 with approximately 1.3 million individuals newly infected during 2022. Similarly, the number of people living with HIV (PWH) has consistently increased in Korea and the number of PWH seeking emergency care is expected to increase. This study aimed to elucidate utilization patterns of emergency department (ED) of PWH and identify key indicators that predict admission and poor prognosis. This was a single-center retrospective study of HIV-positive adult patients who visited the ED between 01 January 2013 and 31 December 2022. Data was collected at the visit level and analyzed using the generalized estimating equation method. Visits were categorized into direct hospital admissions from the ED or discharges to home to evaluate admission-associated factors. Additionally, visits in the poor prognosis group were compared with the remainder to elucidate prognostic indicators. The poor prognosis group was defined as admitted visits with intensive care unit placement, visits with in-hospital mortality, or both. Annually, an average of 8.9 per 10,000 ED visits were made by PWH, with an admission rate of 49.8%. A total of 369 ED visits corresponding to 183 PWH were included in the analysis, and 93% of them were on highly active anti-retroviral therapy. Underlying chronic renal failure, presenting with fever or general weakness, supplemental oxygen administration, or ancillary department consultation in the ED increased admission odds. Ambulance use, high triage level and use of oxygen in the ED were associated with poor prognosis. Most notably, higher levels of blood urea nitrogen (BUN) or lactic acid were independent factors of poor prognosis. We hope these analytic insights from 10 years of institutional data will assist emergency physicians in providing timely informed care to HIV-infected individuals visiting the ED, ultimately leading to improved patient outcomes.

키워드