AEGiS-11IAC: Predictors of survival in advanced AIDS patients admitted to the medical intensive care unit (MICU).

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Predictors of survival in advanced AIDS patients admitted to the medical intensive care unit (MICU).

Int Conf AIDS 1996 Jul 7-12; 11:447 (abstract no. Pub.B.1059)
Williams D, Adams RG, Mody V; Howard University Hospital, Washington, DC. Fax: 202-865-4449.

OBJECTIVE: The policy for admission of advanced AIDS pts to the MICU vary from institution to institution. The present study seeks to predict benefit from admission to the MICU in patients with advanced AIDS.

METHODS: This retrospective study involved 27 pts, 18 men and 9 women, admitted to the MICU at Howard University Hospital, an urban university hospital, between January 1, 1993 and July 1, 1995. Admission diagnoses included respiratory failure, sepsis, pneumonia, anemia and electrolyte imbalance. Nearly 70% of patients were diagnosed with respiratory failure or sepsis.

RESULTS: Pts discharged alive were 37.8 plus or minus 8.41 years of age (NS), pH=7.42 plus or minus .09(NS), pO2=90.9 plus or minus 35.5 (p=.00003), bicarbonate levels=19.25 plus or minus 3.1 (p=.0001), BUN=14.7 plus or minus 9.0 (p is less than .00001) , creatinine = 1.36 plus or minus 1.03 (p=.001) ,mean blood pressure = 79.46 plus or minus 17.9 (p is less than .00001), heart rate=99.8 plus or minus 31.6(p is less than .00001). Pts who were discharged dead from the hospital after a MICU admission tended to have lower levels of oxygen, lower bicarbonate levels, higher BUN and creatinine values and higher mean pressure and higher heart rates. The average CD4 counts for both groups were less than 40 (NS). Interestingly, pts who died were diagnosed with HIV a mean of 1.6 plus or minus 1.6 years prior to the index MICU admission versus pts who were discharged alive who had HIV for 4.02 plus or minus 2.2 years (p is less than .0001).

CONCLUSIONS: 1-Pts who survived the MICU admission tended to have lower resting heart rates and mean blood pressures, suggesting that lower levels of sympathetic input tend to predict survival 2-Pts with longer durations of HIV tended to have greater survival suggesting that these patients may have better follow-up care and use of antiviral medications 3- "less sick" pts i.e those patients without abnormal renal function and normal oxygenation, have the highest survival rates and apparent benefit from MICU admission 4-CD4 count did not predict survival or death. Further studies are necessary to determine the role of MICU admission in the care of advanced AIDS pts.

Keywords: AEGIS, Intensive Care Units, Acquired Immunodeficiency Syndrome, Survival Rate, Retrospective Studies, Patient Discharge, Hospitals, University, Respiratory Insufficiency, Human, Female, Male, mortality, ICA11

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PubB1059