Coexistent HIV infection is not associated with increased in-hospital mortality in critically ill patients with cancer
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LETTER
Coexistent HIV infection is not associated with increased in‑hospital mortality in critically ill patients with cancer Fabrício Rodrigues Torres de Carvalho1,2 , Yeh‑Li Ho3 , Daniel Joelsons3 , Ary Serpa Neto2,4 and Pedro Caruso1,5* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, Human immunodeficiency virus (HIV) infection and cancer frequently coexist [1, 2], and cancer is the leading cause of death among HIV-infected patients in developed countries. Many HIV-infected cancer patients will probably be admitted to the intensive care unit (ICU) in the disease course [3], and the coexistence of these two highly stigmatized diseases can influence ICU admission, prognostication and treatment decisions. However, the impact of HIV infection on critically ill cancer patients is unknown and this knowledge is indispensable for proper ICU admission, therapeutic planning, and counseling of patients and relatives. To evaluate the HIV infection impact on critically ill cancer patients, we explored data collected between January 2000 and December 2018 from ICUs of two hospitals. We compared the characteristics of HIV-infected with the HIV-uninfected critically ill cancer patients and tested the hypothesis that coexistent HIV infection was independently associated with increased in-hospital mortality. We included all adult patients with cancer that required an unplanned ICU admission and excluded HIV-uninfected patients with cancers not presented in our HIVinfected population. Propensity scores were estimated using logistic regression and used to match HIV-infected to HIV-uninfected patients (details on supplementary material) [4]. Based on exposure (HIV) and outcome (in-hospital mortality) [5], patients were matched to ten confounders: age, sex, ICU admission year, SAPS 3 score, *Correspondence: [email protected] 1 Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil Full author information is available at the end of the article
SOFA score, type of tumor (solid or hematological), site of solid tumor, invasive mechanical ventilation use, vasopressors use and acute kidney injury occurrence. In-hospital mortality of HIV-infected patients was compared with in-hospital mortality of matched HIV-uninfected patients. A total of 16,797 cancer patients required an unplanned ICU admission and 7657 were included, among them, 90 patients had HIV infection. Analyzing all included patients (n = 7657), HIV-infected critically ill cancer patients were younger (50 vs 64 years), had more hematological malignancies (43% vs 23%), more intense organ dysfunction upon ICU admission (SOFA 4 vs 2) and required more life-sustaining therapies during ICU stay than unmatched HIV-uninfected patients (58% vs 19% for vasopressors; 44% vs 14% for invasive mechanical ventilation) (p
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