- Paper Report
- Open Access
Do HIV patients fare well in intensive care units?
- Naresh Ramakrishnan1
© Current Science Ltd 2000
- Published: 6 June 2000
- Critical care
- intensive care
Despite the availability of better strategies to decrease the viral load, and consequently the immunosuppression of an individual with HIV, infections are more common and are associated with a higher morbidity and mortality in this group. The provision of intensive care to these patients is challenging, both biologically and emotionally. The clinician requires good data to offer an informed choice to the individual with HIV. This study attempts to provide a sound basis for that.
Retrospective, observational study in 394 adult, HIV infected, patients requiring intensive care
All patients were admitted to the ICU at San Francisco General Hospital, California, USA, between 1992 and 1995
Patients were identified through a billing system and charts were reviewed retrospectively
Survival curves were calculated using the Kaplan-Meier method and logistic regression analysis was used to identify variables that were predictive of death during hospitalization
The mean APACHE II score was 16 (range 0-37), the mean albumin level was 25 g/L (range 10-45) and the mean CD4+ cell count was 108 cells/µL (median 52, range 0-960 cells). Sixty-seven percent of patients were on PCP prophylaxis, and 52% had prior antiretroviral therapy.In total, 245 of the 394 patients (55%) required mechanical ventilation and 21% had PCP. Overall, 24% died in ICU, 13% survived ICU but died in hospital, 63% survived hospitalization.Multiple logistic regression analysis found that the use of mechanical ventilation (risk ratio 1.37, 95%CI 1.08-1074, P = 0.01), CD4+ cell count (< 50 cells/µL), lower serum albumin (< 25 g/L) and current PCP correlated with higher hospital mortality.
The CD4+ cell count is often used as a marker of the level of immunosuppression with < 150 marking immunosuppression and < 50 marking profound immunosuppression. It is important tonote that is a retrospective review, and there are improved antiretroviral strategies available to the clinician today.