EARLY PREDICTORS OF OUTCOME FOR HIV PATIENTS WITH NEUROLOGICAL FAILURE

Objective.-To carry out a descriptive study of human immunodeficiency virus (HIV)-infected patients admitted to an intensive care unit (ICU) with neurological failure and to identify parameters that are predict ive of death within 3 months. Design.-Case series study. Population an d Setting.-A total of 84 consecutive HIV-infected patients admitted to an infectious disease ICU in a university hospital for neurological f ailure. A thorough clinical, laboratory, and brain computed tomography (CT) scan workup was done within 48 hours of admission. Main Results. -The mean (+/-SD) CD4(+) lymphocyte count was 0.067 (+/-0.086) x10(9)/ L. Mechanical ventilation was necessary within 48 hours of admission i n 67 cases (80%). The brain CT scan revealed abscesses in 51 patients (61%). The abscesses were attributed to probable toxoplasmosis in 47 p atients. A total of 57 patients died, yielding a 3-month survival rate of 32%. By the log-rank test, the following factors were predictive o f death within 3 months of admission to the ICU: Glasgow Coma Scale sc ore less than 7 (P=.01), signs of brain stem involvement (P=.001), and need for mechanical ventilation in the 48 hours after admission (P=.0 2). In a Cox model, only Glasgow Coma Scale score less than 7 (P=.006) and clinical signs of brain stem involvement (P=.02) were predictive of death within 3 months of admission to the ICU. Conclusions.-Despite a thorough examination, no initial HIV-specific parameters were ident ified as predictive of death. The prognostic factors found simply refl ected the severity of neurological involvement in the various etiologi es.