Factors predicting survival for HIV-infected patients with respiratory failure

Background: Despite improved treatment modalities, the mortality of HIV inf ected patients admitted to the intensive care unit with respiratory failure remains high. To help ICU physicians in advising HIV infected patients whe ther to undergo mechanical ventilation, we retrospectively investigated pro gnostic factors predicting hospital outcome for HIV-infected patients, admi tted to a medical intensive care unit with respiratory failure before the e ra of highly-active anti-retroviral therapy. Methods: A retrospective chart review was carried out of all HIV-infected p atients with respiratory failure admitted to the medical ICU of a Dutch Uni versity Hospital between 1991 and 1997. Results: In the six year period, 29 HIV-infected patients were admitted to the ICU for respiratory failure. Mechanical ventilation, CD4 cell count, AP ACHE II score, APACHE UI score, ARDS and length of ICU stay all differed si gnificantly between survivors and non-survivors. However, a multivariate an alysis only showed the need for mechanical ventilation as an independent ri sk factor for mortality. The only combination of factors able to accurately predict mortality for the individual patient was the development of ARDS a nd the requirement of mechanical ventilation. Conclusions: The combination of mechanical ventilation and ARDS accurately predicts hospital outcome in HIV-infected patients presenting with respirat ory failure before the HAART era. (C) 2000 Elsevier Science B.V. All rights reserved.