Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Results

Characteristics of the Population
Of the 1,258 admissions during the 3-year study period, 421 (33.5%) were HIV related. Only first ICU admissions were considered and the 67 admissions in patients who had already been admitted to the ICU were excluded from the analysis. The remaining 354 HIV-infected patients form the basis for this analysis. Among them, 280 (79%) had AIDS (according to CDC 1987 surveillance case definition). AIDS was diagnosed prior to the ICU admission in 149 patients, whereas the first AIDS-defining illness was the reason for ICU admission in the remaining 131 AIDS patients. Homosexuality or bisexuality was the most common risk factor (48.3%), followed by IV drug use (27.7%), blood transfusions (6.2%), African/Haitian origin (4.2%), and heterosexual transmission (2.2%). The mode of transmission was unknown in 11.4% of cases. Respiratory failure was the main cause of ICU admission (174 patients, 49.2%), followed by neurologic failure (95 patients, 26.8%), sepsis (36 patients, 10.2%), miscellaneous causes (33 patients, 9.3%), and heart failure (16 patients, 4.5%). Airway Obstruction diagnostic
As shown in Table 1, significant differences were found across admission groups. CD4 counts were different, but the percentage of patients with CD4 lymphocytes <0.100X109/L was not different. For 31 patients for whom CD4 count was not available because their HIV-seropositive status was unknown before ICU admission, we used CD4 count on ICU admission. No differences were found on analysis after exclusion of these patients. Thirty-seven percent of the patients had right heart catheterization, and 8.2% had renal failure requiring hemodialysis. One hundred six patients were admitted with a first defining AIDS condition (30% of all HIV-related admissions). Among them, 50 patients (47.2%) had PCP and 30 patients had toxoplasmic encephalitis (28.3%).
PCP contributed 45.4% (79 patients/174 patients) of respiratory admissions and 22.3% of all HIV-related admissions (79 patients/354 patients). In the PCP patients, Pa02 was 41.2 ±13 mm Hg under room air and 96.1±162 mm Hg with an FIo2=l. Most of the remaining respiratory failure patients had bacterial pneumonia (82 patients/174 patients; 47%). Less frequent respiratory disorders were pulmonary Kaposi’s sarcoma (five patients), toxoplasmic pneumonia (three patients), and pulmonary tuberculosis (five patients).
Table 1—Description of 354 HIV-Infected Patients Admitted to an ICU by Cause of Admission

Respiratory(n=174)”(49.2%) Neurologic(n=95)(26.8%) Cardiac(n=16)(4.5%) Severe Sepsis (n=36) (10.2%) Miscellaneous(n=33)(9.3%) p Value
Pre-ICU variables
Age, yr 36.4±8.6 37.8±11 35.8±8.9 38.6±13 36.6+10 NS
Functional status score 1.58±1.6 1.74±1.3 3.12±0.7 2.02±1.2 1.66±1.1 0.0001
Weight loss, % 11.6±7.4 13±8.5 14.2±9.1 11.5±8.7 10.8±8.6 NS
No. of previousopportunistic infections 0.6±1.02 0.7±1.09 1.75±1.7 0.97±1.3 0.84±1.1 0.001
CD4+ count, 109/L 0.088±0.156 0.067±0.127 0.041 ±0.068 0.085±0.125 0.106±0.131 0.00001
Patients (%) with CD4+ counts <0.100X103/L 78 81 88 74 61 NS
Time since AIDS diagnosis, d 183±273 197±280 423 ±255 363±414 285±311 0.029
AIDS >360 d, % 24 28 57 36 39 0.07
HIV disease stage
AIDS in ICU, % 34 44 7 3 6 0.000001
AIDS prior to ICU, % 42 46 81 66 67
Non-AIDS, % 24 10 12 31 27
Patients with previousantiretroviral treatment, % In-ICU variables 52 47.4 75 66.7 69.7 0.04
SAPS I 12.7±5.4 12.2±4.6 17.1±7.1 18.1±5.3 13.3±6.1 0.00001
Mechanical ventilation, % 36.3 68.4 62.8 61.1 33.3 0.0001
Duration, d 9.6±15 11.4±10 9.9±16 6.8±8.8 3.2±4.5 0.00001

About

So Many Advances in Medicine, So Many Yet to Come