Archive for the ‘HIV’ Category

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

Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Prognostic VariablesSeverity of the acute illness was evaluated using the simplified acute physiology score (SAPS I). Invasive procedures done at any time during the ICU stay (mechanical ventilation and duration of mechanical ventilation, right heart catheterization [Swan-Ganz catheter], and renal failure requiring hemodialysis) were recorded. Continuous positive airway pressure (CPAP) by facial mask and duration of CPAP were recorded only in patients with PCP. Glasgow coma scale scores were recorded during the first day in patients with neurologic impairment. Pa02 on room air (fraction of inspired oxygen [FIo2] = 0.21; and, whenever possible, with an FIo2=1.0 [patients under mechanical ventilation or wearing a facial mask on a CPAP system]) was recorded during the first ICU day in patients with PCP. For the analysis, the following variables were categorized according to their frequency distribution and possible clinical impact: SAPS I (<12, >12) and, in mechanically ventilated patients, the duration of mechanical ventilation (<10 days, >10 days). Airway Read the rest of this entry »

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

A need for mechanical ventilation and the occurrence of renal failure requiring hemodialysis are of adverse significance for the short-term prognosis in ICU patients not infected with the HIV In our study, short-term survival was closely correlated with use of mechanical ventilation or hemodialysis. The duration of mechanical ventilation has been reported as an important prognostic marker in non-HIV-infected patients. Our multivariate analysis found that the duration of mechanical ventilation was significantly associated with a poor short-term outcome; in-ICU mortality rises from 23.7 to 67.6%, and in-hospital mortality goes from 54.2 to 76.2%. Read the rest of this entry »

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

Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: OutcomeWe found that HIV-related variables significantly influenced the in-hospital outcome and to a lesser extent, the in-ICU outcome. These variables were also closely associated with the long-term outcome. The number of previous opportunistic infections, as well as the stage and duration of AIDS, were significantly associated with the short- and long-term outcomes. The CD4 count is the prognostic marker most widely used in HIV-infected patients. However, as shown in Table 3 and Figure 2, differences in median and mean survival times across CD4+ lymphocyte count groups were modest. We believe that variations in CD4+ counts probably have little prognostic value in patients with CD4 counts <0.100X109/L. It has been reported that only logarithmic values are of interest in this population. HIV disease is a chronic disease that remains ultimately fatal, with a life expectancy that varies according to a number of clinical and laboratory marker 25,26 Clearly, the long-term outcome is closely dependent on this specific life expectancy. Bronchial Disease
Read the rest of this entry »

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

Previously reported 1-year survival rates after ICU discharge of non-HIV-infected patients have varied widely in the few available studies, from about 30% in patients with severe sepsis and 49% in elderly subjects (with a mean survival time of 18 ±10 months) to <5% in patients who required cardiopulmonary resuscitation and in bone marrow transplant recipients. Our results in HIV-infected patients compare favorably with those previously reported for other high-risk patients or patients with ultimately fatal illnesses. Treatment of Bronchial Read the rest of this entry »

Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Follotv-up Study After ICU Discharge

Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Follotv-up Study After ICU DischargeCumulative 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. Read the rest of this entry »

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

Overall in-ICU and in-hospital mortality rates were 20.6% and 39.0%; other mortality rates were as follows: respiratory failure group, 16.7% and 33.9%; neurologic failure group, 23.2% and 41.1%; heart failure group, 25.0% and 68.8%; severe sepsis group, 38.9% and 58.3%; and miscellaneous admission causes group, 12.1% and 24.2%. Significant differences were found across admission groups for in-ICU (p=0.026) and in-hospital mortality rates (p=0.002). Mortality rates were lowest in the respiratory and miscellaneous groups, and highest in the neurologic, cardiac, and sepsis groups. Flexible Bronchoscopy
The mean time between ICU discharge and hospital discharge or death was 18.3±15.8 days (median, 20 days).
Results of the univariate and multivariate analysis for short-term outcomes in all 354 patients are presented in Table 2. Read the rest of this entry »

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

Predictors of Short- and Long-term Survival in HIV-Infected Patients Admitted to the ICU: Characteristics of the PopulationThe mean Glasgow coma scale score was 8.9±4 in the neurologic failure admission group. Toxoplasmic encephalitis contributed 62.1% of cases in this group (59 patients/95 patients) and 16.6% of all HIV-related admissions (59 patients/354 patients). A total of 21% of neurologic admissions (20 patients/95 patients) were for intracerebral lesions other than toxoplasmic encephalitis on cerebral imaging studies, including cerebral tuberculosis (5 patients), cryptococcosis (4 patients), nocardiosis (3 patients), cerebral lymphoma (5 patients), or other intracerebral space-occupying lesions such as progressive multifocal leukoencephalitis (3 patients). Patients with predominant clinical features of meningitis accounted for 16.8% (16 patients/95 patients) of neurologic admissions, with the diagnoses being nonopportunis-tic bacterial meningitis (4 patients), tuberculous meningitis (4 patients), nocardiosis (2 patients), and cryptococcal meningitis (6 patients). Causes of heart failure included acute or subacute tuberculous pericarditis (three patients), cryptococcal pericarditis (one patient), cardiac involvement in disseminated toxoplasmosis (one patient), cardiac lymphomas (one patient), beriberi (one patient), and HIV-related dilated cardiomyopathy (nine patients). Read the rest of this entry »

About

So Many Advances in Medicine, So Many Yet to Come