title: 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.
abstract: OBJECTIVE
  To describe the clinical course and prognostic factors in patients with HIV admitted to the ICU.
  
  
  METHODS
  Prospective, observational.
  
  
  METHODS
  A university-affiliated medical center.
  
  
  METHODS
  : 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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Florida Health Science Center, Jacksonville, FL, USA. Afessa.bekele@Mayo.edu
authors.forename: B
authors.initials: B
authors.lastname: Afessa
authors.forename: B
authors.initials: B
authors.lastname: Green
mesh_terms: D018806:APACHE; D000328:Adult; D005260:Female; D005431:Florida; D015658:HIV Infections / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009102:Multiple Organ Failure / Q000150:complications; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome