Sepsis-Related Hospitalizations and Outcomes in HIV-Infected Veterans

Abstract

Introduction: Sepsis continues to be a significant cause of hospitalizations and death especially among HIV-infected patients. However, little is known about the impact of sepsis hospitalizations, hospital mortality, and hospital length of stay (LOS) in HIV-infected patients in the modern era of HIV and sepsis care. Methods: This was a multicenter, retrospective cohort study of 3,449,329 veterans admitted to a Veterans Health Administration (VHA) hospital between January 1st, 2012 and December 31st, 2018. Sepsis was defined using criteria consistent with current definitions set forth by the Surviving Sepsis Campaign (SSC). The proportion of sepsis-related hospitalizations and hospital outcomes were compared between HIV-infected patients and HIV-uninfected patients. A number of potential risk factors including demographics, comorbidities, clinical characteristics of sepsis, and CD4 lymphocyte count were assessed for their impact on mortality in HIV-infected patients by univariable and multivariable analyses adjusting for other risk factors. Results: The proportion of sepsis-related hospitalizations was significantly greater among HIV-infected patients compared to HIV-uninfected patients (5.8% vs. 3.8%; Risk Ratio [RR], 1.51; p < 0.01). Sepsis-related hospital mortality was not different between groups (16.4% vs. 16.0%; RR, 1.02; p = 0.59), while median hospital LOS was longer in HIV-infected patients (10 days vs. 9 days; p < 0.01). In the multivariable logistic regression analysis, cancer (Odds Ratio [OR] 2.24; 95% CI, 1.33-3.77; p < 0.01), hospital onset infection (OR, 2.04; 95% CI, 1.08-3.79; p = 0.03), vasopressor initiation (OR, 12.46; 95% CI, 7.54-20.95; p < 0.01), hepatic injury (OR 2.48; 95% CI, 1.43-4.26; p < 0.01), and hyperlactatemia (OR 2.15; 95% CI, 1.33-3.54; p < 0.01) were associated with increased odds of hospital mortality in HIV-infected patients, while diabetes (OR, 0.42; 95% CI, 0.22-0.78; p < 0.01) was associated with decreased odds of hospital mortality. Decreased CD4 lymphocyte count (< 200 cells/L) was not associated with increased odds of mortality when adjusting for other risk factors (OR 1.13; 95% CI, 0.66-1.89; p = 0.65). Conclusions: Sepsis disproportionally affects HIV-infected patients and results in increased hospital LOS compared to HIV-uninfected patients. Despite sepsis occurring more frequently per hospitalization, sepsis-related hospital mortality does not differ between HIV-infected and HIV-uninfected patients. Certain comorbidities and clinical characteristics may affect risk of sepsis-related hospital mortality in HIV-infected patients.