Medical Intensive Care Unit Admission Among Patients With and Without HIV, Hepatitis C Virus, and Alcohol-Related Diagnoses in the United States: A National, Retrospective Cohort Study, 1997-2014

• Authors: Christopher T. Rentsch, London School of Hygiene and Tropical Medicine; Janet P. Tate, VA Connecticut Healthcare System; Tessa Steel, University of Washington; Adeel A. Butt, VA Pittsburgh Healthcare System; Cynthia L. Gibert, VA Medical Center; Laurence Huang, University of California San Francisco; Margaret Pisani, Yale School of Medicine; Guy W. Soo Hoo, VA Greater Los Angeles Healthcare System; Stephen Crystal, Rutgers State University; Maria C. Rodriguez-Barradas, Michael E DeBakey VA Medical Center; Sheldon T. Brown, James J Peters VA Medical Center; Matthew S. Freiberg, Vanderbilt University; Christopher J. Graber, VA Greater Los Angeles Healthcare System; Joon W. Kim, James J Peters VA Medical Center; David Rimland, Emory University; Amy C. Justice, VA Connecticut Healthcare System; David A. Fiellin, Yale School of Medicine; Kristina A. Crothers, University of Washington; Kathleen M. Akgun, Yale School of Medicine
• Journal Title: Journal of Acquired Immune Deficiency Syndromes
• Volume: Volume 80, Number 2
• Publisher: Wolters Kluwer Health, Inc. | 2019-02-01, Pages 145-151
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/QAI.0000000000001904
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; intensive care units; HIV; hepatitis C; alcoholism; electronic health records; veterans; ANTIRETROVIRAL THERAPY ERA; RISK; MORTALITY; VETERANS; DISEASE; HOSPITALIZATION; INFECTION; PREVALENCE; PATTERNS; IMPACT

Abstract

Background:HIV, hepatitis C virus (HCV), and alcohol-related diagnoses (ARD) independently contribute increased risk of all-cause hospitalization. We sought to determine annual medical intensive care unit (MICU) admission rates and relative risk of MICU admission between 1997 and 2014 among people with and without HIV, HCV, and ARD, using data from the largest HIV and HCV care provider in the United States. Setting:Veterans Health Administration. Methods:Annual MICU admission rates were calculated among 155,550 patients in the Veterans Aging Cohort Study by HIV, HCV, and ARD status. Adjusted rate ratios and 95% confidence intervals (CIs) were estimated with Poisson regression. Significance of trends in age-adjusted admission rates were tested with generalized linear regression. Models were stratified by calendar period to identify shifts in MICU admission risk over time.Results:Compared to HIV-/HCV-/ARD- patients, relative risk of MICU admission decreased among HIV-mono-infected patients from 61% (95% CI: 1.56 to 1.65) in 1997-2009% to 21% (95% CI: 1.16 to 1.27) in 2010-2014, increased among HCV-mono-infected patients from 22% (95% CI: 1.16 to 1.29) in 1997-2009% to 54% (95% CI: 1.43 to 1.67) in 2010-2014, and remained consistent among patients with ARD only at 46% (95% CI: 1.42 to 1.50). MICU admission rates decreased by 48% among HCV-uninfected patients (P-trend <0.0001) but did not change among HCV+ patients (P-trend = 0.34). Conclusion:HCV infection and ARD remain key contributors to MICU admission risk. The impact of each of these conditions could be mitigated with combination of treatment of HIV, HCV, and interventions targeting unhealthy alcohol use.