AIDS in a Medical Intensive Care Unit
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
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.
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.
