Abstract
OBJECTIVE: To determine whether older age continues to influence patterns of care and in-hospital mortality for hospitalized persons with HIV-related Pneumocystis carinii pneumonia PCP), as determined in our prior study from the 1980s. DESIGN: Retrospective chart review. PATIENTS/SETTING: Patients 1,861) with HIV-related PCP at 78 hospitals in 8 cities from 1995 to 1997. MEASUREMENTS: Medical record notation of possible HIV infection; alveolar-arterial oxygen gradient; CD4 lymphocyte count; presence or absence of wasting; timely use of anti-PCP medications; in-hospital mortality. MAIN RESULTS: Compared to younger patients, patients ≥50 years of age were less likely to have HIV mentioned in their progress notes 70% vs 82%, P < .001), have mild or moderately severe PCP cases at admission 89% vs 96%, P < .002), receive anti-PCP medications within the first 2 days of hospitalization 86% vs 93%, P < .002), and survive hospitalization 82% vs 90%, P < .003). However, age was not a significant predictor of mortality after adjustment for severity of PCP and timeliness of therapy. CONCLUSIONS: While inpatient PCP mortality has improved by 50% in the past decade, 2-fold age-related mortality differences persist. As in the 1980s, these differences are associated with lower rates of recognition of HIV, increased severity of illness at admission, and delays in initiation of PCP-specific treatments among older individuals - factors suggestive of delayed recognition of HIV infection, pneumonia, and PCP, respectively. Continued vigilance for the possibility of HIV and HIV-related PCP among persons ≥50 years of age who present with new pulmonary symptoms should be encouraged.
| Original language | English |
|---|---|
| Pages (from-to) | 583-589 |
| Number of pages | 7 |
| Journal | Journal of General Internal Medicine |
| Volume | 16 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 17 2001 |
Fingerprint
Keywords
- Age
- HIV
- Outcomes
- Pneumocystis carinii pneumonia
- Quality of care
ASJC Scopus subject areas
- Internal Medicine
Cite this
HIV-related Pneumocystis carinii pneumonia in older patients hospitalized in the early HAART era. / Kim, B.; Lyons, T. M.; Parada, J. P.; Uphold, C. R.; Yarnold, P. R.; Hounshell, J. B.; Sipler, A. M.; Goetz, M. B.; DeHovitz, J. A.; Weinstein, R. A.; Campo, Rafael E; Bennett, C. L.
In: Journal of General Internal Medicine, Vol. 16, No. 9, 17.09.2001, p. 583-589.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - HIV-related Pneumocystis carinii pneumonia in older patients hospitalized in the early HAART era
AU - Kim, B.
AU - Lyons, T. M.
AU - Parada, J. P.
AU - Uphold, C. R.
AU - Yarnold, P. R.
AU - Hounshell, J. B.
AU - Sipler, A. M.
AU - Goetz, M. B.
AU - DeHovitz, J. A.
AU - Weinstein, R. A.
AU - Campo, Rafael E
AU - Bennett, C. L.
PY - 2001/9/17
Y1 - 2001/9/17
N2 - OBJECTIVE: To determine whether older age continues to influence patterns of care and in-hospital mortality for hospitalized persons with HIV-related Pneumocystis carinii pneumonia PCP), as determined in our prior study from the 1980s. DESIGN: Retrospective chart review. PATIENTS/SETTING: Patients 1,861) with HIV-related PCP at 78 hospitals in 8 cities from 1995 to 1997. MEASUREMENTS: Medical record notation of possible HIV infection; alveolar-arterial oxygen gradient; CD4 lymphocyte count; presence or absence of wasting; timely use of anti-PCP medications; in-hospital mortality. MAIN RESULTS: Compared to younger patients, patients ≥50 years of age were less likely to have HIV mentioned in their progress notes 70% vs 82%, P < .001), have mild or moderately severe PCP cases at admission 89% vs 96%, P < .002), receive anti-PCP medications within the first 2 days of hospitalization 86% vs 93%, P < .002), and survive hospitalization 82% vs 90%, P < .003). However, age was not a significant predictor of mortality after adjustment for severity of PCP and timeliness of therapy. CONCLUSIONS: While inpatient PCP mortality has improved by 50% in the past decade, 2-fold age-related mortality differences persist. As in the 1980s, these differences are associated with lower rates of recognition of HIV, increased severity of illness at admission, and delays in initiation of PCP-specific treatments among older individuals - factors suggestive of delayed recognition of HIV infection, pneumonia, and PCP, respectively. Continued vigilance for the possibility of HIV and HIV-related PCP among persons ≥50 years of age who present with new pulmonary symptoms should be encouraged.
AB - OBJECTIVE: To determine whether older age continues to influence patterns of care and in-hospital mortality for hospitalized persons with HIV-related Pneumocystis carinii pneumonia PCP), as determined in our prior study from the 1980s. DESIGN: Retrospective chart review. PATIENTS/SETTING: Patients 1,861) with HIV-related PCP at 78 hospitals in 8 cities from 1995 to 1997. MEASUREMENTS: Medical record notation of possible HIV infection; alveolar-arterial oxygen gradient; CD4 lymphocyte count; presence or absence of wasting; timely use of anti-PCP medications; in-hospital mortality. MAIN RESULTS: Compared to younger patients, patients ≥50 years of age were less likely to have HIV mentioned in their progress notes 70% vs 82%, P < .001), have mild or moderately severe PCP cases at admission 89% vs 96%, P < .002), receive anti-PCP medications within the first 2 days of hospitalization 86% vs 93%, P < .002), and survive hospitalization 82% vs 90%, P < .003). However, age was not a significant predictor of mortality after adjustment for severity of PCP and timeliness of therapy. CONCLUSIONS: While inpatient PCP mortality has improved by 50% in the past decade, 2-fold age-related mortality differences persist. As in the 1980s, these differences are associated with lower rates of recognition of HIV, increased severity of illness at admission, and delays in initiation of PCP-specific treatments among older individuals - factors suggestive of delayed recognition of HIV infection, pneumonia, and PCP, respectively. Continued vigilance for the possibility of HIV and HIV-related PCP among persons ≥50 years of age who present with new pulmonary symptoms should be encouraged.
KW - Age
KW - HIV
KW - Outcomes
KW - Pneumocystis carinii pneumonia
KW - Quality of care
UR - http://www.scopus.com/inward/record.url?scp=0034853188&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0034853188&partnerID=8YFLogxK
U2 - 10.1046/j.1525-1497.2001.016009583.x
DO - 10.1046/j.1525-1497.2001.016009583.x
M3 - Article
C2 - 11556938
AN - SCOPUS:0034853188
VL - 16
SP - 583
EP - 589
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 9
ER -