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HIV-related emergencies: frequency, diagnoses, and outcome
1Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Objective:
To study the clinical epidemiology and outcome of HIV-related emergencies, and to identify clinical predictors of HIV-related emergency hospitalizations.
Design:
Case series.
Setting:
Emergency facility of a tertiary care teaching hospital.
Patients:
350 HIV/AIDS patients followed at the authors' center.
Measurements And Main Results:
69 of 356 patients made 92 emergency visits with a frequency of 8% per month and 20% per quarter in a three-month study period. Forty-three visits (47%) resulted in hospitalization and contributed to 70% of total AIDS hospitalizations in the period. The five most common acute diagnoses were pneumonia (n = 22; 24%), fever (n = 15; 16%), upper respiratory infection (n = 9; 10%), cellulitis (n = 6; 7%), and gastroenteritis (n = 6; 7%). Three diagnoses accounted for 70% of acute HIV hospitalizations: pneumonia (n = 19), fever (n = 4), and sepsis (n = 4). Analysis of patient disposition as it relates to the patient's clinical presentation and HIV history using multivariate analysis yielded 1) the presence of dyspnea or cough (p = 0.015) and 2) fever with an abnormal chest x-ray (p = 0.008) as independently predictive of hospitalization.
Conclusion:
The findings indicate that HIV/AIDS patients have a frequent need for emergency care and most HIV/AIDS hospitalizations are emergency-related. The acute problems of these patients are related to a limited number of diagnostic categories, and the presence of respiratory or constitutional symptoms with an abnormal chest radiograph are the only reliable factors predictive of hospitalization.