Predictors of mortality for patients with advanced disease in an HIV palliative care program

Jennifer M. Shen, Arthur Blank, Peter A. Selwyn

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Despite advances in treatment, AIDS and its associated comorbidities remain important causes of death. Traditional HIV prognostic markers may be less useful in predicting death in current late-stage patients than in the era before highly active antiretroviral therapy. Methods: We used standardized baseline and follow-up data to describe causes of death and predictors of mortality in a cohort of patients with advanced disease referred to a specialized HIV palliative care program at a large urban medical center. Results: Of 230 patients, 56% were male with a median age of 43 years; 54% were Hispanic and 39% were African American; 41% had a history of injection drug use; 89% had prior AIDS-defining illnesses; and median baseline values included a CD4+ count of 39 cells/mm3, HIV viral load of 65,202 copies/mL, Kamofsky score of 30, and 5 impaired activities of daily living (ADL). Over a median follow-up of 126 days (range: 1-823 days), 120 patients died; 54% of these died of late-stage HIV disease and/or bacterial pneumonia or sepsis, 19% of non-AIDS-defining cancers, 13% of liver failure and/or cirrhosis, and 12% of other progressive end-organ disease (eg, cardiac, pulmonary, renal). On multivariate analysis, death was predicted only by age (>65 years), baseline number of ADL impairments, and Karnofsky score (P < 0.0001 for all) and not by any AIDS-specific variables. Conclusions: For patients with late-stage disease referred to an HIV palliative care program, age and markers of functional status were more predictive of mortality than traditional HIV prognostic variables. Close to half of all deaths were attributable to non-AIDS-specific causes, including cancer and end-organ failure. These findings suggest the need for renewed study of predictors of mortality and prognostic markers in patients with advanced HIV disease and related comorbidities in the HAART era.

Original languageEnglish (US)
Pages (from-to)445-447
Number of pages3
JournalJournal of Acquired Immune Deficiency Syndromes
Volume40
Issue number4
DOIs
StatePublished - Dec 2005

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Palliative Care
HIV
Mortality
Acquired Immunodeficiency Syndrome
Highly Active Antiretroviral Therapy
Activities of Daily Living
Comorbidity
Cause of Death
Bacterial Pneumonia
Liver Failure
Liver Neoplasms
CD4 Lymphocyte Count
Viral Load
Hispanic Americans
Liver Cirrhosis
African Americans
Heart Diseases
Sepsis
Multivariate Analysis
Kidney

Keywords

  • Mortality
  • Palliative care
  • Prognostic markers

ASJC Scopus subject areas

  • Virology
  • Immunology

Cite this

Predictors of mortality for patients with advanced disease in an HIV palliative care program. / Shen, Jennifer M.; Blank, Arthur; Selwyn, Peter A.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 40, No. 4, 12.2005, p. 445-447.

Research output: Contribution to journalArticle

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abstract = "Background: Despite advances in treatment, AIDS and its associated comorbidities remain important causes of death. Traditional HIV prognostic markers may be less useful in predicting death in current late-stage patients than in the era before highly active antiretroviral therapy. Methods: We used standardized baseline and follow-up data to describe causes of death and predictors of mortality in a cohort of patients with advanced disease referred to a specialized HIV palliative care program at a large urban medical center. Results: Of 230 patients, 56{\%} were male with a median age of 43 years; 54{\%} were Hispanic and 39{\%} were African American; 41{\%} had a history of injection drug use; 89{\%} had prior AIDS-defining illnesses; and median baseline values included a CD4+ count of 39 cells/mm3, HIV viral load of 65,202 copies/mL, Kamofsky score of 30, and 5 impaired activities of daily living (ADL). Over a median follow-up of 126 days (range: 1-823 days), 120 patients died; 54{\%} of these died of late-stage HIV disease and/or bacterial pneumonia or sepsis, 19{\%} of non-AIDS-defining cancers, 13{\%} of liver failure and/or cirrhosis, and 12{\%} of other progressive end-organ disease (eg, cardiac, pulmonary, renal). On multivariate analysis, death was predicted only by age (>65 years), baseline number of ADL impairments, and Karnofsky score (P < 0.0001 for all) and not by any AIDS-specific variables. Conclusions: For patients with late-stage disease referred to an HIV palliative care program, age and markers of functional status were more predictive of mortality than traditional HIV prognostic variables. Close to half of all deaths were attributable to non-AIDS-specific causes, including cancer and end-organ failure. These findings suggest the need for renewed study of predictors of mortality and prognostic markers in patients with advanced HIV disease and related comorbidities in the HAART era.",
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