Clinical Course, Prognostic Factors, and Outcome Prediction for HIV Patients in the ICU
| Autor: | Bekele Afessa, Bethany Green |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty ARDS APACHE II business.industry Mortality rate Critical Care and Intensive Care Medicine medicine.disease Intensive care unit law.invention Systemic inflammatory response syndrome Standardized mortality ratio Respiratory failure law Internal medicine Medicine Cardiology and Cardiovascular Medicine business Intensive care medicine Cause of death |
| Zdroj: | Chest. 118:138-145 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.118.1.138 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
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