AIDS IN A MEDICAL INTENSIVE-CARE UNIT - IMMEDIATE PROGNOSIS AND LONG-TERM SURVIVAL

Objective.-To help physicians decide whether to admit patients with ac quired immunodeficiency syndrome (AIDS) to the medical intensive care unit (MICU). Design.-Case series study of AIDS patients admitted to th e MICU between October 1990 and October 1992 and followed up until Apr il 1993 (median follow-up, 1 year). Setting.-The MICU in a 970-bed tea ching hospital in Paris, France. Patients.-A total of 120 consecutive AIDS patients with acute respiratory failure (50%), central nervous sy stem dysfunction (22.5%), pneumothorax (12.5%), shock (10.8%), or misc ellaneous conditions (4.2%), A fetal of 86 patients were discharged al ive from the MICU. Main Outcome Measures.-Predictive factors for morta lity during and after MICU stay. Results.-Multivariate analysis identi fied 3 factors predicting poor MICU outcome: Simplified Acute Physiolo gy Score I (SAPS I) above 10 (relative risk [RR], 6.1, 95% confidence interval [CI]: 1.5-26.6), time between AIDS diagnosis and MICU admissi on more than 1 year(RR, 6.0; 95% CI, 2.1-17.5), serum albumin level le ss than 30 g/L (RR, 4.9; 95% CI, 1.3-18.2). The CD4 cell count, beta(2 )-microglobulinemia, and previous opportunistic infections had no infl uence on MICU mortality. After MICU discharge, survival rates were 86% al 1 week, 82% at 1 month, 53% at 6 months, and 39% at 1 year, The Ka rnofsky scale score and the number of previous opportunistic infection s were simultaneously associated with post-MICU outcome. Predictive fa ctors for MICU survival did not influence post-MICU survival. Conclusi on.-The MICU mortality was related to immediate severity (assessed wit hin 48 hours of admission) and the time between AIDS diagnosis and MIC U admission. Long-term survival after MICU discharge depended only on the severity of AIDS. We conclude that AIDS patients should be admitte d to the MICU on the same basis as other patients.