Outcomes of intensive care for patients with human immunodeficiency virus infection

Background: Intensive tare for patients with human immunodeficiency virus i s common, costly, and associated with high morbidity. Accurate and up-to-da te outcome and prognostic data are needed to effectively counsel patients a nd to make difficult decisions regarding admission to the intensive care un it. Methods: We reviewed the medical charts of 394 adults infected with human i mmunodeficiency virus who received intensive care at San Francisco General Hospital, San Francisco, Calif, from 1992 to 1995, and we performed a multi variate analysis to learn which factors were predictive of poor outcomes. Results: Respiratory failure (47%), sepsis (12%), and neurologic disease (1 146) were the most common indications for admission to the intensive care u nit. Overall, 63% of the patients survived hospitalization; survival rates were 27%, 18%, 13%, and 11% at 1, 2, 3, and 4 years, respectively. Independ ent predictors of hospital mortality were low serum albumin level, Acute Ph ysiology Score, mechanical ventilation, and a diagnosis of Pneumocystis car inii pneumonia during admission to the intensive care unit. Low CD4(+) cell count, low serum albumin level, and mechanical ventilation predicted poor long-term survival. Of the 121 patients who had a CD4(+) cell count less th an SO cells/mu L (0.05 x 10(9)/L) and a serum albumin level less than 25 g/ L and required mechanical ventilation, 7% survived for 2.5 years or more af ter hospital discharge. Conclusions: In this series, which is the largest to date of patients admit ted to the intensive care unit with human immunodeficiency virus infection, we found that long-term survival rates were low. However, even among patie nts who had multiple risk factors for mortality, a substantial minority sur vived, with a few patients achieving long-term survival.