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.