SEPTIC SHOCK IN PATIENTS WITH THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Objective: To evaluate the prognosis of patients with septic shock adm itted to an intensive care unit (ICU), according to their HIV serostat us. Design: Retrospective study. Setting: Medical ICU of a university hospital, Patients: 76 patients with septic shock. admitted to the sam e ICU, of whom 28 were HIV positive and 48 were HIV negative, Measurem ents and results: Severity scores, number and type of organ failures, and survival rates were assessed in the two groups of patients. Glasgo w Coma Scale and general severity scores [Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score (SAPS)I we re significantly worse in HIV-infected patients. The total number of o rgan failures was also higher in the HIV-positive group: 3.7 +/- 0.2 v s 3.1 +/- 0.2 in the 21 (46 %) HIV-negative patients were dead compare d to 26 (93 %) patients in the HIV-positive group (p < 0.001), In the multivariate analysis, HIV infection was an independent risk factor fo r mortality, as were the SAPS score, use of mechanical ventilation, an d the McCabe score. Conclusions: This study reports a considerable exc ess mortality in HIV-infected patients with septic shock. Although sev erity of illness was clearly much more pronounced in HPV-positive pati ents, retroviral infection was independently associated with death, Im proving survival in HIV-positive patients with septic shock may requir e earlier diagnosis and treatment of the causative infection.