Early predictors of outcome for HIV patients with neurological failure.
OBJECTIVE
To carry out a descriptive study of human immunodeficiency virus (HIV)-infected patients admitted to an intensive care unit (ICU) with neurological failure and to identify parameters that are predictive of death within 3 months.


METHODS
Case series study.


METHODS
A total of 84 consecutive HIV-infected patients admitted to an infectious disease ICU in a university hospital for neurological failure. A thorough clinical, laboratory, and brain computed tomography (CT) scan workup was done within 48 hours of admission.


RESULTS
The mean (+/- SD) CD4+ lymphocyte count was 0.067 (+/- 0.086) x 10(9)/L. Mechanical ventilation was necessary within 48 hours of admission in 67 cases (80%). The brain CT scan revealed abscesses in 51 patients (61%). The abscesses were attributed to probable toxoplasmosis in 47 patients. A total of 57 patients died, yielding a 3-month survival rate of 32%. By the log-rank test, the following factors were predictive of death within 3 months of admission to the ICU: Glasgow Coma Scale score less than 7 (P = .01), signs of brain stem involvement (P = .001), and need for mechanical ventilation in the 48 hours after admission (P = .02). In a Cox model, only Glasgow Coma Scale score less than 7 (P = .006) and clinical signs of brain stem involvement (P = .02) were predictive of death within 3 months of admission to the ICU.


CONCLUSIONS
Despite a thorough examination, no initial HIV-specific parameters were identified as predictive of death. The prognostic factors found simply reflected the severity of neurological involvement in the various etiologies.
Bédos
J P
JP
Infectious Intensive Care Unit, Bichat-Claude Bernard University Hospital, Paris, France.
Chastang
C
C
Lucet
J C
JC
Kalo
T
T
Gachot
B
B
Wolff
M
M
D015526:AIDS Dementia Complex / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D005260:Female; D015600:Glasgow Coma Scale; D015658:HIV Infections / Q000150:complications / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015996:Survival Rate; D014056:Tomography, X-Ray