Prognoses indicators of HIV patients admitted to the ICU

Introduction

The level of immunity in HIV patients is associated with a high mortality, particularly when CD4⁺ lymphocytes are inferior to 200 cells/mm³. Besides the immunity, other prognoses indicators are necessary.

Methods

The author performed a revision of 1,028 admissions to the ICU from January 2007 and November 2009. Selected were the cases of HIV patients with low immunity (L CD4⁺ <200 cells/mm³). The following parameters were collected at admission to the ICU: viral load, LDH, albumin, hemoglobin, Hct, thrombocytopenia, presence of opportunistic infection, nutritional status, need for mechanical ventilation, renal insufficiency and history of antiretroviral therapy (ART). Demographic parameters were also collected. The primary endpoint was mortality, secondary endpoints were ICU length stay and days of mechanical ventilation.

Results

Fifteen patients were selected; all of them were medical admissions mainly from the emergency department. Sixty-five percent had previous history of opportunistic infection, and only two patients had ART. The main reason to suspend ART was social and drug-dependency problems. Sepsis was diagnosed in 73% of the patients. Pneumocystis carinii pneumonia was diagnosed in 80% of the patients. Fungus infection was diagnosed in 60% of patients. One patient had pulmonary tuberculosis and another had Leishmania infection. The mortality rate was 53%. The factors associated with high mortality were: P. carinii pneumonia, malnutrition and absence of ART.

Conclusions

The patient's nutritional status is an independent predictor of mortality in HIV patients.