HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (23) Citing Articles via Google Scholar Google Scholar Articles by Afessa, B. Articles by Green, B. Search for Related Content PubMed PubMed Citation Articles by Afessa, B. Articles by Green, B.

Clinical Course, Prognostic Factors, and Outcome Prediction for HIV Patients in the ICU^*

The PIP (Pulmonary Complications, ICU Support, and Prognostic Factors in Hospitalized Patients With HIV) Study

^* From the Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Florida Health Science Center, Jacksonville, FL.

Correspondence to: Bekele Afessa, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: Afessa.bekele{at}Mayo.edu

Study objective: To describe the clinical course and prognostic factors in patients with HIV admitted to the ICU.

Design: Prospective, observational.

Setting: A university-affiliated medical center.

Methods: We included 169 consecutive ICU admissions, from April 1995 through March 1999, of 141 adults with HIV. Data collected included APACHE (acute physiology and chronic health evaluation) II score, CD4⁺ lymphocyte count, serum albumin level, in-hospital mortality, and the development of organ failure, systemic inflammatory response syndrome (SIRS), and ARDS.

Results: The ICU admission rate of hospitalized patients with HIV infection was 12%. The most common reason for ICU admission was respiratory failure, occurring in 65 patient admissions. Mechanical ventilation was required in 91 admissions (54%), ARDS developed in 37 admissions (22%), Pneumocystis carinii pneumonia was diagnosed in 24 admissions (14%), and SIRS developed in 126 admissions (75%). One or more organ failures developed in 131 admissions (78%). The actual and predicted mortality rates were 29.6% and 45.2%, respectively, with a standardized mortality ratio of 0.65. The most frequent immediate cause of death was bacterial infection. The CD4⁺ lymphocyte count (median, 27.5 cells/µL vs 59 cells/µL; p = 0.0310) and serum albumin level (median 2.2 g/dL vs 2.6 g/dL; p = 0.0355) of nonsurvivors were lower and the APACHE II score (median, 30 vs 21; p < 0.0001) was higher, compared to those of survivors. A higher APACHE II score (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.05 to 1.16) and a transfer from another hospital ward (OR, 3.03; 95% CI, 1.20 to 7.68) were independently associated with increased mortality. The median number of organ failures that developed in survivors was one, compared to four in nonsurvivors (p < 0.0001).

Conclusions: The outcome of HIV-infected patients admitted to the ICU has improved over the years. The CD4 count does not correlate with in-hospital mortality. Higher APACHE II scores and a transfer from another hospital ward are associated with a poor outcome.

Key Words: AIDS • APACHE • ARDS • HIV • ICU admission • organ failure • outcome • Pneumocystis carinii pneumonia • respiratory failure • systemic inflammatory response syndrome

This article has been cited by other articles:

				R F Miller, E Allen, A Copas, M Singer, and S G Edwards Improved survival for HIV infected patients with severe Pneumocystis jirovecii pneumonia is independent of highly active antiretroviral therapy Thorax, August 1, 2006; 61(8): 716 - 721. [Abstract] [Full Text] [PDF]

				H. Khouli, A. Afrasiabi, M. Shibli, R. Hajal, C. R. Barrett, and P. Homel Outcome of Critically Ill Human Immunodeficiency Virus-Infected Patients in the Era of Highly Active Antiretroviral Therapy J Intensive Care Med, December 1, 2005; 20(6): 279 - 285. [Abstract] [PDF]

				R J Boyton, D M Mitchell, and O M Kon The pulmonary physician in critical care * Illustrative case 5: HIV associated pneumonia Thorax, August 1, 2003; 58(8): 721 - 725. [Full Text] [PDF]

				A. Morris, J. Creasman, J. Turner, J. M. Luce, R. M. Wachter, and L. Huang Intensive Care of Human Immunodeficiency Virus-infected Patients during the Era of Highly Active Antiretroviral Therapy Am. J. Respir. Crit. Care Med., August 1, 2002; 166(3): 262 - 267. [Abstract] [Full Text] [PDF]

				B. Afessa, I. Morales, and J. D. Cury Clinical Course and Outcome of Patients Admitted to an ICU for Status Asthmaticus Chest, November 1, 2001; 120(5): 1616 - 1621. [Abstract] [Full Text] [PDF]