Predictors of the short- and long-term survival of HIV-infected patients admitted to a Brazilian intensive care unit

Abstract

The outcomes of HIV-infected patients requiring critical care have improved. However, in developing countries, information about HIV-infected patients admitted to intensive care units (ICUs) is scarce. We describe the prognosis of HIV-infected patients admitted to a Brazilian ICU and the factors predictive of short- and long-term survival. A historical cohort study, including HIV-infected patients admitted to a Brazilian ICU at an HIV/AIDS reference hospital, was conducted. Survivors were followed up for 24 months after ICU discharge. Demographic, clinical and laboratory data, disease severity scores and mortality were evaluated. Data were analysed using survival and regression models. One hundred and twenty-five patients were studied. In-ICU and in-hospital mortality rates were 46.4% and 68.0%, respectively. Multivariate analysis showed that the in-ICU mortality was significantly associated with APACHE (Acute Physiology and Chronic Health Evaluation) II scores (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.03–1.11), mechanical ventilation (OR, 6.39; 95% CI, 1.29–31.76), tuberculosis treatment (OR, 2.62; 95% CI, 1.03–6.71), use of antiretroviral therapy (OR, 0.19; 95% CI, 0.05–0.77) and septic shock (OR, 4.38; 95% CI, 1.78–10.76). Septic shock was also associated with long-term survival (hazard ratio, 3.0; 95% CI, 1.31–6.90). In-hospital and in-ICU mortality were higher than those reported for developed countries. ICU admission mostly due to AIDS-related diseases may explain these differences.