Mortality and length of stay among HIV patients hospitalized for heart failure: A multicenter retrospective study.

ABSTRACT

Study objective: The purpose of our study was to determine if CD4+ T-lymphocyte count (CD4 count) was inversely associated with inpatient mortality and length of stay (LOS) among patients with HIV hospitalized for acute heart failure. Design: Retrospective cohort study. Setting: HCA hospitals throughout the United States. Participants: 1704 patients with human immunodeficiency virus (HIV) hospitalized for acute heart failure with a documented, time-updated CD4 count. Interventions: Patients were categorized by CD4 count ranges consisting of >500, 200-499, <200 cells/µL. Main outcome measures: A multivariable negative binomial regression was performed with CD4 count as a predictor of length of stay. Multivariable logistic regression was performed with CD4 count as a predictor of mortality. Results: A CD4 count <200 cells/µL was associated with an increased length of stay compared to a CD4 > 500 cells/µL (IRR 1.24, 95 % CI 1.11 to 1.39, P ≤ 0.01). A CD4 of 200-499 cells/µL was associated with a shorter LOS compared to a CD4 < 200 cells/µL (IRR 0.82, 95 % CI 0.75 to 0.89, P ≤ 0.01). A CD4 < 200 cells/µL was associated with an increased mortality compared to a CD4 > 500 cells/µL (OR 3.62, 95 % CI 1.63 to 8.05, P ≤ 0.01). CD4 count was not independently associated with in-patient mortality after adjusting for viral load. Conclusion: A time-updated CD4 count <200 cells/µL on hospital admission was independently associated with increased length of stay. CD4 cell count and viral load are important markers when considering the morbidity and mortality among patients with HIV hospitalized for acute heart failure.