Septic shock in patients with the acquired immunodeficiency syndrome.
OBJECTIVE
To evaluate the prognosis of patients with septic shock admitted to an intensive care unit (ICU), according to their HIV serostatus.


METHODS
Retrospective study.


METHODS
Medical ICU of a university hospital.


METHODS
76 patients with septic shock admitted to the same ICU, of whom 28 were HIV positive and 48 were HIV negative.


RESULTS
Severity scores, number and type of organ failures, and survival rates were assessed in the two groups of patients. Glasgow Coma Scale and general severity scores [Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score (SAPS)] were significantly worse in HIV-infected patients. The total number of organ failures was also higher in the HIV-positive group: 3.7 +/- 0.2 vs 3.1 +/- 0.2 in the HIV-negative group (p < 0.001). On day 28, 21 (46%) HIV-negative patients were dead compared to 26 (93%) patients in the HIV-positive group (p < 0.001). In the multivariate analysis, HIV infection was an independent risk factor for mortality, as were the SAPS score, use of mechanical ventilation, and the McCabe score.


CONCLUSIONS
This study reports a considerable excess mortality in HIV-infected patients with septic shock. Although severity of illness was clearly much more pronounced in HIV-positive patients, retroviral infection was independently associated with death. Improving survival in HIV-positive patients with septic shock may require earlier diagnosis and treatment of the causative infection.
Thyrault
M
M
Infectious Diseases Department, Bichat-Claude Bernard Hospital, Paris, France.
Gachot
B
B
Chastang
C
C
Souweine
B
B
Timsit
J F
JF
Bédos
J P
JP
Régnier
B
B
Wolff
M
M
D017088:AIDS-Related Opportunistic Infections / Q000145:classification / Q000401:mortality*; D018806:APACHE; D000328:Adult; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012772:Shock, Septic / Q000145:classification / Q000209:etiology / Q000401:mortality*; D016019:Survival Analysis