J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 12, Number 4, April 2020, pages 233-242

In-Hospital Cardiopulmonary Resuscitation of Patients With Human Immunodeficiency Virus Infection: A Population-Based Cohort Study of Epidemiology and Outcomes

Figure 1. Temporal trends of risk-adjusted short-term survival following in-hospital cardiopulmonary resuscitation. Short-term survival is defined as that of hospitalizations without in-hospital death or discharge to hospice. Hospitalizations with HIV are represented by box markers, and those without HIV are represented by diamond markers. Short-term survival estimates were adjusted for age, race/ethnicity, health insurance, Deyo comorbidity index, myocardial infarction, cerebrovascular disease, diabetes, weekend admission, sepsis, shockable rhythm, number of organ failures, and year of admission. HIV: human immunodeficiency virus; 95% CI: 95% confidence interval; AAPC: average annual percent change.

**Table 1.** The Characteristics of Hospitalizations With In-Hospital Cardiopulmonary Resuscitation, With and Without HIV
Variables	HIV (n = 437)	Non-HIV (n = 54,135)	P
HIV: human immunodeficiency virus; SD: standard deviation. ^aGender is not reported for HIV hospitalizations and was reported in 49,777 hospitalizations without HIV; the percent figure for gender among the latter refers to that column’s denominator for gender. ^bMean (SD). Percentage figures may not add to 100 due to rounding.
Age, years (%)			< 0.0001
18 - 44	200 (45.8)	5,407 (10.0)
45 - 64	202 (46.2)	18,183 (33.6)
≥ 65	5 (8.0)	30,545 (56.4)
Gender^a
Female	NA	23,251 (46.7)	NA
Race/ethnicity (%)			< 0.0001
White	89 (20.4)	27,144 (50.1)
Hispanic	78 (17.8)	11,471 (21.2)
Black	247 (56.5)	10,284 (19.0)
Other	18 (4.1)	4,617 (8.5)
Missing	5 (1.1)	619 (1.1)
Health insurance (%)			< 0.0001
Private	93 (21.3)	14,448 (26.7)
Medicare	143 (32.7)	29,831 (55.1)
Medicaid	120 (27.5)	3,780 (7.0)
Uninsured	78 (17.8)	5,207 (9.6)
Other	3 (0.7)	774 (1.4)
Missing	NA	95 (0.2)
Deyo comorbidity index^b	6.1 (2.1)	2.6 (2.3)	< 0.0001
Selected comorbidities
Myocardial infarction	59 (13.5)	14,372 (26.5)	< 0.0001
Congestive heart failure	113 (25.9)	22,204 (41.5)	< 0.0001
Cerebrovascular disease	29 (6.6)	6,056 (11.2)	0.0026
Renal disease	155 (35.5)	18,376 (33.9)	0.5027
Liver disease	104 (23.8)	9,130 (16.9)	0.0001
Diabetes	80 (18.3)	20,883 (38.6)	< 0.0001
Malignancy	47 (10.8)	6,029 (11.3)	0.8005
Teaching hospital	163 (37.3)	13,973 (25.8)	< 0.0001
Sepsis	324 (74.1)	30,454 (56.3)	< 0.0001
Number of organ failures	2.9 (1.4)	2.6 (1.4)	< 0.0001
Weekend admission	109 (24.9)	12,452 (23)	0.3370
Shockable rhythm	31 (7.1)	6,468 (11.9)	0.0018
Hospital disposition
Death	343 (78.5)	37,841 (69.9)	0.0001
Hospice	11 (2.5)	1,769 (3.3)	0.3790
Home	39 (8.9)	6,254 (11.6)	0.0867
Another hospital	22 (5.0)	5,570 (10.3)	0.0003
Nursing facility	15 (3.4)	2,379 (4.4)	0.3280

Table 1. The Characteristics of Hospitalizations With In-Hospital Cardiopulmonary Resuscitation, With and Without HIV

Variables

HIV (n = 437)

Non-HIV (n = 54,135)

HIV: human immunodeficiency virus; SD: standard deviation. ^aGender is not reported for HIV hospitalizations and was reported in 49,777 hospitalizations without HIV; the percent figure for gender among the latter refers to that column’s denominator for gender. ^bMean (SD). Percentage figures may not add to 100 due to rounding.

Age, years (%)

< 0.0001

18 - 44

200 (45.8)

5,407 (10.0)

45 - 64

202 (46.2)

18,183 (33.6)

≥ 65

5 (8.0)

30,545 (56.4)

Gender^a

Female

23,251 (46.7)

Race/ethnicity (%)

< 0.0001

White

89 (20.4)

27,144 (50.1)

Hispanic

78 (17.8)

11,471 (21.2)

Black

247 (56.5)

10,284 (19.0)

Other

18 (4.1)

4,617 (8.5)

Missing

5 (1.1)

619 (1.1)

Health insurance (%)

< 0.0001

Private

93 (21.3)

14,448 (26.7)

Medicare

143 (32.7)

29,831 (55.1)

Medicaid

120 (27.5)

3,780 (7.0)

Uninsured

78 (17.8)

5,207 (9.6)

Other

3 (0.7)

774 (1.4)

Missing

95 (0.2)

Deyo comorbidity index^b

6.1 (2.1)

2.6 (2.3)

< 0.0001

Selected comorbidities

Myocardial infarction

59 (13.5)

14,372 (26.5)

< 0.0001

Congestive heart failure

113 (25.9)

22,204 (41.5)

< 0.0001

Cerebrovascular disease

29 (6.6)

6,056 (11.2)

0.0026

Renal disease

155 (35.5)

18,376 (33.9)

0.5027

Liver disease

104 (23.8)

9,130 (16.9)

0.0001

Diabetes

80 (18.3)

20,883 (38.6)

< 0.0001

Malignancy

47 (10.8)

6,029 (11.3)

0.8005

Teaching hospital

163 (37.3)

13,973 (25.8)

< 0.0001

Sepsis

324 (74.1)

30,454 (56.3)

< 0.0001

Number of organ failures

2.9 (1.4)

2.6 (1.4)

< 0.0001

Weekend admission

109 (24.9)

12,452 (23)

0.3370

Shockable rhythm

31 (7.1)

6,468 (11.9)

0.0018

Hospital disposition

Death

343 (78.5)

37,841 (69.9)

0.0001

Hospice

11 (2.5)

1,769 (3.3)

0.3790

Home

39 (8.9)

6,254 (11.6)

0.0867

Another hospital

22 (5.0)

5,570 (10.3)

0.0003

Nursing facility

15 (3.4)

2,379 (4.4)

0.3280

**Table 2.** Temporal Changes Among Hospitalizations With In-Hospital Cardiopulmonary Resuscitation, With and Without HIV
Category	Year	AAPC (95% CI)	P
AAPC: average annual percent change; 95% CI: 95% confidence interval; HIV: human immunodeficiency virus. ^aRate of cardiopulmonary resuscitation per 1,000 hospitalizations among all hospitalizations within a specific stratum. ^bPercent of cardiopulmonary resuscitation among all patients who died in the hospital within a specific stratum. ^cShort-term survival was defined as that of hospitalizations without in-hospital death or discharge to hospice.
Rate of CPR (all)^a
HIV	4.8	4.8	4.7	3.3	4.9	3.9	-3.8 (-14.4 to +6.8)	0.3769
Non-HIV	3.9	3.9	4	4.2	4.3	4.4	2.7 (1.9 to 3.5)	0.0009
CPR among decedents (%)^b
HIV	11.4	11.7	12.4	8.1	12.5	9.6	-3.1 (-15.1 to +8.8)	0.5104
Non-HIV	12.9	12.7	13.2	13.5	13.3	13.5	1.1 (0.1 to 2.1)	0.0376
Shockable rhythm (%)
HIV	10.1	3.9	7.9	1.8	9.8	7.4	-0.8 (-50.7 to +49.1)	0.967
Non-HIV	11.1	11.8	11.4	12.4	11.8	12.9	2.4 (0.01 to 4.7)	0.0483
Short-term survival (%)^c
All
HIV	12.7	14.3	18.4	23.6	25.6	20.6	12.6 (1.8 to 23.4)	0.0315
Non-HIV	24.8	26.6	26	28	27.8	27.2	1.9 (-0.2 to 4.0)	0.0654
Shockable rhythm
HIV	12.5	33.3	33.3	100	12.5	0	-74.2 (-101.5 to +73.5)	0.2354
Non-HIV	36.4	36.1	34.7	36.9	39.1	36.8	1.6 (-1.6 to +3.9)	0.307
Non-shockable rhythm
HIV	12.7	13.5	17.1	22.2	27	20.6	13.6 (2.6 to 24.6)	0.0263
Non-HIV	23.4	25.4	25	26.8	26.4	25.8	-1.3 (-8.2 to +5.7)	0.6359

Table 2. Temporal Changes Among Hospitalizations With In-Hospital Cardiopulmonary Resuscitation, With and Without HIV

Variables	Unadjusted odds ratio (95% CI)	P	Adjusted odds ratio (95% CI)	P
HIV: human immunodeficiency virus; 95% CI: 95% confidence interval.
Health insurance
Private	Reference		Reference
Medicare	2.11 (1.07 - 4.16)	0.0300	1.58 (0.93 - 2.69)	0.0896
Medicaid	1.19 (0.57 - 2.50)	0.633	NA
No insurance	0.73 (0.30 - 1.80)	0.5033	NA
Other	0.52 (0.37 - 3.09)	0.9983	NA
Deyo comorbidity index	0.86 (0.73 - 0.92)	0.0397	NA
Congestive heart failure	3.14 (1.90 - 5.18)	< 0.0001	2.03 (1.20 - 3.46)	0.0084
Cerebrovascular disease	1.69 (1.15 - 3.73)	0.0074	2.08 (1.15 - 3.75)	0.0148
Diabetes	4.56 (1.55 - 13.40)	0.0057	1.53 (1.31 - 4.71)	0.0195
Teaching hospital	1.54 (0.95 - 2.50)	0.0771	NA
Year of admission	1.16 (1.02 - 1.33)	0.0336	1.13 (1.07 - 1.31)	0.0251

Category	Year						AAPC (95% CI)	P
Category	2009	2010	2011	2012	2013	2014	AAPC (95% CI)	P
AAPC: average annual percent change; 95% CI: 95% confidence interval; HIV: human immunodeficiency virus. ^aRate of cardiopulmonary resuscitation per 1,000 hospitalizations among all hospitalizations within a specific stratum. ^bPercent of cardiopulmonary resuscitation among all patients who died in the hospital within a specific stratum. ^cShort-term survival was defined as that of hospitalizations without in-hospital death or discharge to hospice.
Rate of CPR (all)^a
HIV	4.8	4.8	4.7	3.3	4.9	3.9	-3.8 (-14.4 to +6.8)	0.3769
Non-HIV	3.9	3.9	4	4.2	4.3	4.4	2.7 (1.9 to 3.5)	0.0009
CPR among decedents (%)^b
HIV	11.4	11.7	12.4	8.1	12.5	9.6	-3.1 (-15.1 to +8.8)	0.5104
Non-HIV	12.9	12.7	13.2	13.5	13.3	13.5	1.1 (0.1 to 2.1)	0.0376
Shockable rhythm (%)
HIV	10.1	3.9	7.9	1.8	9.8	7.4	-0.8 (-50.7 to +49.1)	0.967
Non-HIV	11.1	11.8	11.4	12.4	11.8	12.9	2.4 (0.01 to 4.7)	0.0483
Short-term survival (%)^c
All
HIV	12.7	14.3	18.4	23.6	25.6	20.6	12.6 (1.8 to 23.4)	0.0315
Non-HIV	24.8	26.6	26	28	27.8	27.2	1.9 (-0.2 to 4.0)	0.0654
Shockable rhythm
HIV	12.5	33.3	33.3	100	12.5	0	-74.2 (-101.5 to +73.5)	0.2354
Non-HIV	36.4	36.1	34.7	36.9	39.1	36.8	1.6 (-1.6 to +3.9)	0.307
Non-shockable rhythm
HIV	12.7	13.5	17.1	22.2	27	20.6	13.6 (2.6 to 24.6)	0.0263
Non-HIV	23.4	25.4	25	26.8	26.4	25.8	-1.3 (-8.2 to +5.7)	0.6359

Variables	Unadjusted odds ratio (95% CI)	P	Adjusted odds ratio (95% CI)	P
HIV: human immunodeficiency virus; 95% CI: 95% confidence interval.
Age (years)
18 - 44	Reference		Reference
45 - 64	0.92 (0.85 - 0.97)	0.005	0.81 (0.76 - 0.87)	< 0.0001
≥ 65	0.67 (0.63 - 0.72)	< 0.0001	0.53 (0.49 - 0.57)	< 0.0001
Race/ethnicity
White	Reference		Reference
Hispanic	0.91 (0.86 - 0.95)	0.0001	0.90 (0.86 - 0.95)	0.0001
Black	0.87 (0.83 - 0.92)	< 0.0001	0.86 (0.82 - 0.91)	< 0.0001
Other	0.97 (0.90 -1.04)	0.3318	NA
Health insurance
Private	Reference		Reference
Medicare	0.77 (0.74 - 0.81)	< 0.0001	0.86 (0.81 - 0.90)	< 0.0001
Medicaid	0.94 (0.86 - 1.01)	0.1033	NA
No insurance	0.72 (0.66 - 0.77)	< 0.0001	0.67 (0.63 - 0.73)	< 0.0001
Other	0.85 (0.72 - 1.01)	0.0538	NA
HIV	0.64 (0.50 - 0.81)	0.0003	0.50 (0.39 - 0.65)	< 0.0001
Deyo comorbidity index	0.94 (0.93 - 0.95)	< 0.0001	0.95 (0.92 - 0.97)	< 0.0001
Myocardial infarction	1.17 (1.12 - 1.22)	< 0.0001	1.13 (1.08 - 1.18)	< 0.0001
Congestive heart failure	1.36 (1.31 - 1.41)	< 0.0001	NA
Cerebrovascular disease	1.16 (1.09 - 1.23)	< 0.0001	1.19 (1.12 - 1.27)	< 0.0001
Diabetes	1.50 (1.41 - 1.61)	0.0047	1.32 (1.23 - 1.42)	< 0.0001
Malignancy	0.35 (0.31 - 0.40)	< 0.0001	NA
Sepsis	0.87 (0.83 - 0.90)	< 0.0001	0.84 (0.77 - 0.92	< 0.0001
Weekend admission	0.89 (0.86 - 0.94)	< 0.0001	0.93 (0.90 - 0.98)	0.01
Teaching hospital	0.99 (0.95 - 1.03)	0.6078	NA
Number of organ failures	0.88 (0.87 - 0.90)	< 0.0001	0.86 (0.85 - 0.88)	< 0.0001
Shockable rhythm	1.65 (1.56 - 1.74)	< 0.0001	1.58 (1.50 - 1.68)	< 0.0001
Year of admission	1.02 (1.01 - 1.04)	< 0.0001	1.03 (1.02 - 1.04)	< 0.0001