This Article  • References  • Full text PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Immediate Prognosis and Long-term Survival

Thierry Lazard, MD; Olivier Retel, PhD; Bertrand Guidet, MD; Eric Maury, MD; Alain-Jacques Valleron, PhD; Georges Offenstadt, MD

JAMA. 1996;276(15):1240-1245.

Abstract
Objective.
—To help physicians decide whether to admit patients with acquired immunodeficiency syndrome (AIDS) to the medical intensive care unit (MICU).

Design.
—Case series study of AIDS patients admitted to the MICU between October 1990 and October 1992 and followed up until April 1993 (median follow-up, 1 year).

Setting.
—The MICU in a 970-bed teaching hospital in Paris, France.

Patients.
—A total of 120 consecutive AIDS patients with acute respiratory failure (50%), central nervous system dysfunction (22.5%), pneumothorax (12.5%), shock (10.8%), or miscellaneous conditions (4.2%). A total of 86 patients were discharged alive from the MICU.

Main Outcome Measures.
—Predictive factors for mortality during and after MICU stay.

Results.
—Multivariate analysis identified 3 factors predicting poor MICU outcome: Simplified Acute Physiology Score I (SAPS I) above 10 (relative risk [RR], 6.1; 95% confidence interval [CI], 1.5-26.6), time between AIDS diagnosis and MICU admission more than 1 year (RR, 6.0; 95% CI, 2.1-17.5), serum albumin level less than 30 g/L (RR, 4.9; 95% CI, 1.3-18.2). The CD4 cell count, β2-microglobulinemia, and previous opportunistic infections had no influence on MICU mortality. After MICU discharge, survival rates were 86% at 1 week, 82% at 1 month, 53% at 6 months, and 39% at 1 year. The Karnofsky scale score and the number of previous opportunistic infections were simultaneously associated with post-MICU outcome. Predictive factors for MICU survival did not influence post-MICU survival.

Conclusion.
—The MICU mortality was related to immediate severity (assessed within 48 hours of admission) and the time between AIDS diagnosis and MICU admission. Long-term survival after MICU discharge depended only on the severity of AIDS. We conclude that AIDS patients should be admitted to the MICU on the same basis as other patients.

Author Affiliations
From the Service de Réanimation Polyvalente (Drs Lazard, Guidet, Maury, and Offenstadt) and the Unité de Biostatistiques et Informatique Médicale (Drs Retel and Valleron), Hôpital Saint-Antoine, Paris, France.

Footnotes
Corresponding author: Thierry Lazard, MD, Service de Réanimation Polyvalente, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France.

Concepts in Emergency and Critical Care section editor: Roger C. Bone, MD, Consulting Editor, JAMA.

Advisory Panel: Bart Chernow, MD, Baltimore, Md; David Dantzker, MD, New Hyde Park, NY; Jerrold Leiken, MD, Chicago, III; Joseph E. Parrillo, MD, Chicago, III; William J. Sibbald, MD, London, Ontario; and Jean-Louis Vincent, MD, PhD, Brussels, Belgium.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Outcome of Critically Ill Human Immunodeficiency Virus-Infected Patients in the Era of Highly Active Antiretroviral Therapy
Khouli et al.
J Intensive Care Med 2005;20:279-285.
ABSTRACT  

Intensive Care of Patients With Human Immunodeficiency Virus Infection: Time to Take Another Look
Rosen
J Intensive Care Med 2005;20:312-315.
 

Intensive Care of Human Immunodeficiency Virus-infected Patients during the Era of Highly Active Antiretroviral Therapy
Morris et al.
Am. J. Respir. Crit. Care Med. 2002;166:262-267.
ABSTRACT | FULL TEXT  

Reappraisal of the aetiology and prognostic factors of severe acute respiratory failure in HIV patients
Alves et al.
Eur Respir J 2001;17:87-93.
ABSTRACT | FULL TEXT  

Clinical Course, Prognostic Factors, and Outcome Prediction for HIV Patients in the ICU : The PIP (Pulmonary Complications, ICU Support, and Prognostic Factors in Hospitalized Patients With HIV) Study
Afessa and Green
Chest 2000;118:138-145.
ABSTRACT | FULL TEXT  

Outcomes of Intensive Care for Patients With Human Immunodeficiency Virus Infection
Nickas and Wachter
Arch Intern Med 2000;160:541-547.
ABSTRACT | FULL TEXT  

AIDS in the Intensive Care Unit
AIDS Clin Care 1996;1996:10-10.
FULL TEXT  

SHOULD PATIENTS WITH AIDS BE BANNED FROM ICUs?
JWatch General 1996;1996:6-6.
FULL TEXT