Isaline Coquet, Juliette Pavie, Pierre Palmer, Francois Barbier, Stephane Legriel, Julien Mayaux, Jean-michel Molina, Benoit Schlemmer, Elie Azoulay. Critical Care 2010, 14:R107 (9 June 2010)
Introduction: The widespread use of highly active antiretroviral therapy (HAART) has reduced HIV-related life threatening infectious complications. Our objective was to assess whether HAART was associated with improved survival in critically ill HIV-infected patients.
Methods: Retrospective study from 1996 to 2005 in a medical ICU in a University hospital specialized in management of immunocompromized patients. 284 critically ill HIV-infected patients were included. Differences were sought across four time periods. Risk factors for death were identified by multivariable logistic regression.
Results: Among the 233 (82%) patients with known HIV infection before ICU admission, 64% were on HAART. Annual admissions increased over time, with no differences in reasons for admission; proportions of patients with newly diagnosed HIV, previous opportunistic infection, CD4 counts, viral load, or acute disease severity. ICU and 90-day mortality rates decreased steadily: 25% and 37.5% in 1996-1997, 17.1% and 17.1% in 1998-2000, 13.2% and 13.2% in 2001-2003, and 8.6% in 2004-2005. Four factors were independently associated with increased ICU mortality: delayed ICU admission [odds ratio (OR), 3.04; 95% confidence interval (CI), 1.29-7.17), acute renal failure (OR, 4.21; 95% CI, 1.63-10.92), hepatic cirrhosis (OR, 3.78; 95% CI, 1.21-11.84), ICU admission for coma (OR, 2.73; 95% CI, 1.16-6.46), and severe sepsis (OR, 3.67; 95% CI, 1.53-8.80. Admission to the ICU in the most recent period was independently associated with increased survival: admission from 2001 to 2003 (OR, 0.28; 95%CI, 0.08-0.99), and between 2004 and 2005 (OR, 0.13; 95%CI, 0.03-0.53).
Conclusions: ICU survival increased significantly in the HAART era, although disease severity remained unchanged. Co-morbidities and organ dysfunctions, but not HIV-related variables, were associated with death. Earlier ICU admission from the hospital ward might improve survival.
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