Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study

O.S. Soegaard; N. Lohse; J. Gerstoft; G. Kronborg; L. Ostergaard; C. Pedersen; G. Pedersen; H.T. Sorensen; N. Obel; Ole S Søgaard; Nicolai Lohse; Jan Gerstoft; Gitte Kronborg; Lars Østergaard; Court Pedersen; Gitte Pedersen; Henrik Toft Sørensen; Niels Obel

doi:10.1371/journal.pone.0007022

Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study

O.S. Soegaard, N. Lohse, J. Gerstoft, G. Kronborg, L. Ostergaard, C. Pedersen, G. Pedersen, H.T. Sorensen, N. Obel, Ole S Søgaard, Nicolai Lohse, Jan Gerstoft, Gitte Kronborg, Lars Østergaard, Court Pedersen, Gitte Pedersen, Henrik Toft Sørensen, Niels Obel

Department of Clinical Medicine

16 Citations (Scopus)

Abstract

BACKGROUND: HIV-infected persons are at increased risk of pneumonia, even with highly active antiretroviral treatment (HAART). We examined the impact of pneumonia on mortality and identified prognostic factors for death among HIV-infected. METHODOLOGY/PRINCIPAL FINDINGS: In a nationwide, population-based cohort of individuals with HIV, we included persons hospitalized with pneumonia from the Danish National Hospital Registry and obtained mortality data from the Danish Civil Registration System. Comparing individuals with and without pneumonia, we used Poisson regression to estimate relative mortality and logistic regression to examine prognostic factors for death following pneumonia. From January 1, 1995, to July 1, 2008, we observed 699 episodes of first hospitalization for pneumonia among 4,352 HIV patients. Ninety-day mortality after pneumonia decreased from 22.4% (95% confidence interval [CI]: 16.5%-28.9%) in 1995-1996 to 8.4% (95% CI: 6.1%-11.6%) in 2000-2008. Mortality remained elevated for more than a year after hospitalization for pneumonia: adjusted mortality rate ratio 5.38 (95% CI: 4.27-6.78), 1.80 (95% CI: 1.36-2.37), and 1.62 (95% CI: 1.32-2.00) for days 0-90, 91-365, and 366+, respectively. The following variables predicted mortality within 90 days following hospitalization for pneumonia (adjusted Odds Ratios): male sex (3.77, 95% CI: 1.37-10.4), Charlson Comorbidity Index score > or = 2 (3.86, 95% CI: 2.19-6.78); no current HAART (3.58, 95% CI: 1.83-6.99); history of AIDS (2.46, 95% CI: 1.40-4.32); age per 10 year increase (1.43, 95% CI: 1.11-1.85); and CD4+ cell count < or = 200 (2.52, 95% CI: 1.37-4.65). CONCLUSIONS/SIGNIFICANCE: The first hospitalization for pneumonia among HIV-infected individuals was associated with elevated risk of death up to more than a year later. Use of HAART decreased the risk, independent of current CD4+ cell count. Prognosis following pneumonia improved over calendar time.

Original language	English
Journal	PLoS ONE
Volume	4
Issue number	9
Pages (from-to)	e7022
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0007022 https://doi.org/10.1371/journal.pone.0007022
Publication status	Published - 2009

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Soegaard, O. S., Lohse, N., Gerstoft, J., Kronborg, G., Ostergaard, L., Pedersen, C., Pedersen, G., Sorensen, H. T., Obel, N., Søgaard, O. S., Lohse, N., Gerstoft, J., Kronborg, G., Østergaard, L., Pedersen, C., Pedersen, G., Sørensen, H. T., & Obel, N. (2009). Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study. PLoS ONE, 4(9), e7022. https://doi.org/10.1371/journal.pone.0007022, https://doi.org/10.1371/journal.pone.0007022

Soegaard, OS, Lohse, N, Gerstoft, J , Kronborg, G, Ostergaard, L, Pedersen, C, Pedersen, G, Sorensen, HT, Obel, N, Søgaard, OS, Lohse, N, Gerstoft, J, Kronborg, G, Østergaard, L, Pedersen, C, Pedersen, G, Sørensen, HT & Obel, N 2009, 'Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study', PLoS ONE, vol. 4, no. 9, pp. e7022. https://doi.org/10.1371/journal.pone.0007022, https://doi.org/10.1371/journal.pone.0007022

@article{55ba1aa059a511df928f000ea68e967b,

title = "Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study",

abstract = "BACKGROUND: HIV-infected persons are at increased risk of pneumonia, even with highly active antiretroviral treatment (HAART). We examined the impact of pneumonia on mortality and identified prognostic factors for death among HIV-infected. METHODOLOGY/PRINCIPAL FINDINGS: In a nationwide, population-based cohort of individuals with HIV, we included persons hospitalized with pneumonia from the Danish National Hospital Registry and obtained mortality data from the Danish Civil Registration System. Comparing individuals with and without pneumonia, we used Poisson regression to estimate relative mortality and logistic regression to examine prognostic factors for death following pneumonia. From January 1, 1995, to July 1, 2008, we observed 699 episodes of first hospitalization for pneumonia among 4,352 HIV patients. Ninety-day mortality after pneumonia decreased from 22.4% (95% confidence interval [CI]: 16.5%-28.9%) in 1995-1996 to 8.4% (95% CI: 6.1%-11.6%) in 2000-2008. Mortality remained elevated for more than a year after hospitalization for pneumonia: adjusted mortality rate ratio 5.38 (95% CI: 4.27-6.78), 1.80 (95% CI: 1.36-2.37), and 1.62 (95% CI: 1.32-2.00) for days 0-90, 91-365, and 366+, respectively. The following variables predicted mortality within 90 days following hospitalization for pneumonia (adjusted Odds Ratios): male sex (3.77, 95% CI: 1.37-10.4), Charlson Comorbidity Index score > or = 2 (3.86, 95% CI: 2.19-6.78); no current HAART (3.58, 95% CI: 1.83-6.99); history of AIDS (2.46, 95% CI: 1.40-4.32); age per 10 year increase (1.43, 95% CI: 1.11-1.85); and CD4+ cell count < or = 200 (2.52, 95% CI: 1.37-4.65). CONCLUSIONS/SIGNIFICANCE: The first hospitalization for pneumonia among HIV-infected individuals was associated with elevated risk of death up to more than a year later. Use of HAART decreased the risk, independent of current CD4+ cell count. Prognosis following pneumonia improved over calendar time.",

author = "O.S. Soegaard and N. Lohse and J. Gerstoft and G. Kronborg and L. Ostergaard and C. Pedersen and G. Pedersen and H.T. Sorensen and N. Obel and S{\o}gaard, {Ole S} and Nicolai Lohse and Jan Gerstoft and Gitte Kronborg and Lars {\O}stergaard and Court Pedersen and Gitte Pedersen and S{\o}rensen, {Henrik Toft} and Niels Obel",

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doi = "10.1371/journal.pone.0007022",

language = "English",

volume = "4",

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journal = "PLoS Computational Biology",

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T1 - Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study

AU - Soegaard, O.S.

AU - Lohse, N.

AU - Gerstoft, J.

AU - Kronborg, G.

AU - Ostergaard, L.

AU - Pedersen, C.

AU - Pedersen, G.

AU - Sorensen, H.T.

AU - Obel, N.

AU - Søgaard, Ole S

AU - Lohse, Nicolai

AU - Gerstoft, Jan

AU - Kronborg, Gitte

AU - Østergaard, Lars

AU - Pedersen, Court

AU - Pedersen, Gitte

AU - Sørensen, Henrik Toft

AU - Obel, Niels

PY - 2009

Y1 - 2009

N2 - BACKGROUND: HIV-infected persons are at increased risk of pneumonia, even with highly active antiretroviral treatment (HAART). We examined the impact of pneumonia on mortality and identified prognostic factors for death among HIV-infected. METHODOLOGY/PRINCIPAL FINDINGS: In a nationwide, population-based cohort of individuals with HIV, we included persons hospitalized with pneumonia from the Danish National Hospital Registry and obtained mortality data from the Danish Civil Registration System. Comparing individuals with and without pneumonia, we used Poisson regression to estimate relative mortality and logistic regression to examine prognostic factors for death following pneumonia. From January 1, 1995, to July 1, 2008, we observed 699 episodes of first hospitalization for pneumonia among 4,352 HIV patients. Ninety-day mortality after pneumonia decreased from 22.4% (95% confidence interval [CI]: 16.5%-28.9%) in 1995-1996 to 8.4% (95% CI: 6.1%-11.6%) in 2000-2008. Mortality remained elevated for more than a year after hospitalization for pneumonia: adjusted mortality rate ratio 5.38 (95% CI: 4.27-6.78), 1.80 (95% CI: 1.36-2.37), and 1.62 (95% CI: 1.32-2.00) for days 0-90, 91-365, and 366+, respectively. The following variables predicted mortality within 90 days following hospitalization for pneumonia (adjusted Odds Ratios): male sex (3.77, 95% CI: 1.37-10.4), Charlson Comorbidity Index score > or = 2 (3.86, 95% CI: 2.19-6.78); no current HAART (3.58, 95% CI: 1.83-6.99); history of AIDS (2.46, 95% CI: 1.40-4.32); age per 10 year increase (1.43, 95% CI: 1.11-1.85); and CD4+ cell count < or = 200 (2.52, 95% CI: 1.37-4.65). CONCLUSIONS/SIGNIFICANCE: The first hospitalization for pneumonia among HIV-infected individuals was associated with elevated risk of death up to more than a year later. Use of HAART decreased the risk, independent of current CD4+ cell count. Prognosis following pneumonia improved over calendar time.

AB - BACKGROUND: HIV-infected persons are at increased risk of pneumonia, even with highly active antiretroviral treatment (HAART). We examined the impact of pneumonia on mortality and identified prognostic factors for death among HIV-infected. METHODOLOGY/PRINCIPAL FINDINGS: In a nationwide, population-based cohort of individuals with HIV, we included persons hospitalized with pneumonia from the Danish National Hospital Registry and obtained mortality data from the Danish Civil Registration System. Comparing individuals with and without pneumonia, we used Poisson regression to estimate relative mortality and logistic regression to examine prognostic factors for death following pneumonia. From January 1, 1995, to July 1, 2008, we observed 699 episodes of first hospitalization for pneumonia among 4,352 HIV patients. Ninety-day mortality after pneumonia decreased from 22.4% (95% confidence interval [CI]: 16.5%-28.9%) in 1995-1996 to 8.4% (95% CI: 6.1%-11.6%) in 2000-2008. Mortality remained elevated for more than a year after hospitalization for pneumonia: adjusted mortality rate ratio 5.38 (95% CI: 4.27-6.78), 1.80 (95% CI: 1.36-2.37), and 1.62 (95% CI: 1.32-2.00) for days 0-90, 91-365, and 366+, respectively. The following variables predicted mortality within 90 days following hospitalization for pneumonia (adjusted Odds Ratios): male sex (3.77, 95% CI: 1.37-10.4), Charlson Comorbidity Index score > or = 2 (3.86, 95% CI: 2.19-6.78); no current HAART (3.58, 95% CI: 1.83-6.99); history of AIDS (2.46, 95% CI: 1.40-4.32); age per 10 year increase (1.43, 95% CI: 1.11-1.85); and CD4+ cell count < or = 200 (2.52, 95% CI: 1.37-4.65). CONCLUSIONS/SIGNIFICANCE: The first hospitalization for pneumonia among HIV-infected individuals was associated with elevated risk of death up to more than a year later. Use of HAART decreased the risk, independent of current CD4+ cell count. Prognosis following pneumonia improved over calendar time.

U2 - 10.1371/journal.pone.0007022

DO - 10.1371/journal.pone.0007022

M3 - Journal article

C2 - 19750011

SN - 1932-6203

VL - 4

SP - e7022

JO - PLoS Computational Biology

JF - PLoS Computational Biology

IS - 9

ER -

Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study

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