PURPOSE: Identify the clinical characteristics and prognostic factors of HIV-infected patients admitted to ICU.Analyze the outcome of critically ill HIV-infected patients in terms of morbidity&mortality.
METHODS: All HIV-infected adult-patients admitted to medical/surgical-ICU at inner-city community-hospital over 3-years-period.Data collection included:demographic-characteristics,admission-diagnoses,data from ICU&hospital-stay,physiologic-data,data on hospital-course,&final-outcome.
RESULTS: 112patient-encounters-included;mean-age-47yrs,males-63%,African American-97%,White-2%,&Hispanic-1%.Diagnoses of:AIDS-62%,HIV-38%;use of prior-ART-43%;PCP-prophylaxis-30%;MAC-prophylaxis 13%;prior opportunistic-infection/malignancy-27%.Use of mechanical-ventilation70%,development of PCP-6%,encephalopathy 52%,mean CD4-count=141,mean-albumin-level=2.3,mean-ventilator days=7,mean-length of hospital-stay=14,mean-length of ICU-stay 6.5=days,discharged-home41%;long-term acute-care discharge21%. The Overall-mortality was-38%.Mortality among those who required mechanicalventilation was45%Vs21% for those with no-mechanical-ventilation(P-value=0.017).Morbidity-outcomes:in-terms of LOS,development of encephalopathy,PCP,mean number of organ-dysfunction,discharged-home were compared among those who required mechanical-ventilation Vs no-mechanical-ventilation and were significantly-associated with increased:LOS(8Vs2days,P-value< 0.0001),development of encephalopathy(59%Vs35%,P-value 0.023),more organ-dysfunction(3Vs2,P-value=0.006).Mortality among those who have CD4-count< 200 Vs >200 was 49%Vs14%(P-value=0.002),albumin< 2 Vs >2 was 61%Vs24%(P-value< 0.0001),AIDS Vs HIV-Infection 51%Vs16%(P-value< 0.0001).Diagnosis of AIDS,need for mechanical-ventilation,development of encephalopathy were independent risk-factors for in-hospital mortality signified by P-values of0.019,0.006&0.010 respectively.However,CD4-count and development of PCP were not independent risk-factors for in-hospital mortality.
CONCLUSION: Intensive care for HIV infected patients is associated with increased mortality and morbidity.Respiratory failure was the most common reason for ICU admission with very high rate of intubation. Need for mechanical ventilation was associated with significant increase in morbidity and mortality. Diagnosis of AIDS, need for mechanical ventilation and development of encephalopathy were independent predictors of poor outcome.
CLINICAL IMPLICATIONS: Identifying the prognostic factors and analyzing the outcome of critically ill HIV- infected patients are helpful for effective triaging of admissions to ICU and counseling these patients and their families.
DISCLOSURE: Tanuja Kulasinghe, No Financial Disclosure Information; No Product/Research Disclosure Information