Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Follotv-up Study After ICU Discharge
Cumulative survival rates in the 281 patients who were discharged from the ICU were 51 ±38% at 6 months, 28±38% at 12 months, and 18±30% at 24 months. Table 3 shows long-term outcome univariate and multivariate analysis results, as well as crude mean and median survival times. Figure 1 shows survival curves according to the admission cause group and functional status, and Figure 2 shows survival curves according to HIV disease stage and CD4+ count. Bronchoscopy
Median and mean survival times were 429 days and 432±331 days in the PCP subgroup vs 311 days and 391 ±392 days in the other respiratory failure causes subgroup (p — 0.32). In the neurologic failure group, median and mean survival times were 75 days and 202 ±253 days in the toxoplasmic encephalitis subgroup, 34 days and 88 ±116 days in the intracerebral space-occupying lesion subgroup, and 188 days and 299 ±360 days in the meningitis subgroup; these differences were not statistically significant.
Functional Status in Surviving Patients at the Study End
Sixty-eight HIV-infected patients were alive at the end of the study period (January 1, 1994). Functional status data were available for 47 of these patients, after a mean follow-up of 682±302 days (median, 602 days). Functional status was not significantly different at study completion (1.89±0.88 [median, 2]) as compared with before ICU admission (2.04±1.35 [median, 2]; p=0.5 by Wilcoxon’s test).
The short-term mortality rates for our HlV-in-fected patients were comparable to recently reported overall mortality rates for non-HIV-infected patients admitted to ICUs. Although the in-hospital mortality rate in our study may seem high, there is ample documentation that in-hospital mortality rates are twice as high as in-ICU mortality rates. When each admission group is considered separately, our data are also comparable to previously published results. For example, mortality in patients with severe sepsis has approximated 40% in non-HIV-infected patients, whereas in the present study, the in-ICU and in-hospital mortality rates for HIV-infected patients with severe sepsis were 40% and 58%, respectively.
Figure 1. Survival curves for 281 patients discharged alive from the ICU according to the admission cause (top) and the functional status (bottom).
Figure 2. Survival curves for 281 patients discharged alive from the ICU according to the HIV disease stage (top) and the CD4 count at admission (bottom)
Table 3—Long-term Outcome
|Median, d||Mean±SD, d||Univariatef p Value||Multivariate* p Value RR (95% Cl)|
|Overall survival times||199||316±343|
|Weight loss, %||0.00002||0.00001|
|>12||89||237 ±298||1.9 (1-2.1)|
|0.201-0.300||516||494 ±393||0.4 (0.3-0.46)|
|>0.301||555||489 ±429||0.2 (0.2-0.28)|
|1 or 2||36||161±217|
|HIV disease stage||0.000001||0.01|
|AIDS prior to ICU||48||188±251||1|
|AIDS in ICU||332||376±332||0.8 (0.67-0.95)|
|Duration of AIDS, d||0.0002||0.001|
|Neurologic failure||75||199 ±264||1.24(1.13-1.36)|
|Heart failure||36||139 ±287||1.53 (1.40-1.68)|
|>12||13||162 ±261||2.92 (2.11-4.12)|
|Yes||7||150 ±268||2.11 (1.38-3.21)|