Afessa B, Green B
Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Florida Health Science Center, Jacksonville, FL, USA.
Chest. 2000 Jul;118(1):138-45. doi: 10.1378/chest.118.1.138.
To describe the clinical course and prognostic factors in patients with HIV admitted to the ICU.
Prospective, observational.
A university-affiliated medical center.
: 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.
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/microL vs 59 cells/microL; 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 < 0.0001) was higher, compared to those of survivors. A higher APACHE II score (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.05 to 1.16) and a transfer from another hospital ward (OR, 3.03; 95% CI, 1.20 to 7.68) were independently associated with increased mortality. The median number of organ failures that developed in survivors was one, compared to four in nonsurvivors (p < 0.0001).
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.
描述入住重症监护病房（ICU）的HIV患者的临床病程及预后因素。
前瞻性观察研究。
一所大学附属医院医疗中心。
我们纳入了1995年4月至1999年3月期间141例成年HIV患者连续169次入住ICU的病例。收集的数据包括急性生理与慢性健康状况评估（APACHE）II评分、CD4（+）淋巴细胞计数、血清白蛋白水平、院内死亡率以及器官衰竭、全身炎症反应综合征（SIRS）和急性呼吸窘迫综合征（ARDS）的发生情况。
HIV感染住院患者的ICU入住率为12%。入住ICU最常见的原因是呼吸衰竭，有65例患者为此原因入住。91例（54%）需要机械通气，37例（22%）发生ARDS，24例（14%）诊断为卡氏肺孢子虫肺炎，126例（75%）发生SIRS。131例（78%）出现一种或多种器官衰竭。实际死亡率和预测死亡率分别为29.6%和45.2%，标准化死亡率为0.65。最常见的直接死亡原因是细菌感染。与存活者相比，非存活者的CD4（+）淋巴细胞计数（中位数，27.5个/微升对59个/微升；p = 0.0310）和血清白蛋白水平（中位数2.2克/分升对2.6克/分升；p = 0.0355）较低，而APACHE II评分（中位数，30对21；p < 0.0001）较高。较高的APACHE II评分（优势比[OR]，1.11；95%置信区间[CI]，1.05至1.16）和从其他医院病房转入（OR，3.03；95%CI，1.20至7.68）与死亡率增加独立相关。存活者发生器官衰竭的中位数为1个，而非存活者为4个（p < 0.0001）。
多年来，入住ICU的HIV感染患者的预后有所改善。CD4计数与院内死亡率无关。较高的APACHE II评分和从其他医院病房转入与不良预后相关。
