THE ROLE OF FUNCTIONAL STATUS IN PREDICTING INPATIENT MORTALITY WITH AIDS - A COMPARISON WITH CURRENT PREDICTORS

To assess the independent prognostic role of functional status, as ref lected by a measure of an inpatient's global requirement for nursing a ssistance with basic activities of daily living (Global ADL), we compa red Global ADL with three validated AIDS mortality predictors: the Cli nical AIDS Prognostic Staging (CAPS); the Severity Classification Syst em for AIDS Hospitalizations-version 2 (SCAH-2); and CD4 cell count, O ur study sample consisted of 1392 patients with AIDS and a hospital st ay of 3 or more days at one of 20 hospitals in 11 U.S. cities with hig h AIDS incidence. Data were collected from September 1990 through Dece mber 1991, Two percent of patients refused participation, and 26% were eliminated due to incomplete data collection, leaving an analytic sam ple of 1003 patients. Only 30% of patients had a CD4 count measured at any time during hospitalization. Cox regression was used to measure t he hazard of inpatient mortality adjusted for length of stay. Overall mortality was 12%. Mortality rates for patients in Global ADL stages I -IV were 3%, 8%, 19%, and 51%, respectively (P < 0.0001), Global ADL m ore effectively discriminated mortality than CAPS (p < 0.001), SCAH-2 (p < 0.001), or CD4 count (p < 0.001). Global ADL also added independe nt information in analyses adjusted for both CAPS and SCAH-2: a single stage increase of Global ADL demonstrated a 1.9-fold increased hazard of death (CI: 1.6, 2.3), SCAH-2, assigned at discharge, was not stron gly correlated with admission predictors (Global ADL: r = 0.17; CI: 0. 11, 0.23 or CAPS: r = 0.03, CI: 0.02, 0.17). We conclude that Global A DL, alone or in tandem with other severity systems, provides an excell ent severity adjustment for inpatient mortality with AIDS. Finally, CD 4 cell counts were not routinely available and were not as predictive as Global ADL in the patients for whom both were available.