11th International AIDS Conference Vancouver, British Columbia — July 7-12, 1996

Int Conf AIDS 1996 Jul 7-12; 11:229 (abstract no. Tu.B.111)
Curtis JR, Horner RD, Bennett CL; Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA. Fax: (206) 731-8584.

OBJECTIVES: Two small studies have reported that no patients survived after 2 weeks in an intensive care unit (ICU) for PCP, suggesting that ICU care should be withdrawn after 2 weeks. The goal of this study is to examine the association between length of stay in an ICU and survival to hospital discharge for patients with HIV-related PCP.

METHODS: Chart review of a representative sample of patients with HIV-related PCP hospitalized in a random sample of 73 private, 9 public, and 14 VA hospitals in Chicago, New York, LA, Miami, and Durham, NC, from 1987 to 1990.

RESULTS: Data were collected for 2174 patients with PCP, of whom 398 (18%) were cared for in an ICU. Of the patients cared for in an ICU, 197 (49%) survived to hospital discharge. Survival to discharge was strongly associated with length of stay in the ICU: for 1 to 7 days in the ICU (n=207) survival was 58%; 8 to 14 days (n=111) survival was 52%; 15 to 21 days (n=80) survival was 24%. Patients with a prior AIDS-defining illness were less likely to survive ICU care to discharge (36% vs. 55%; p=0.004). Among patients with a prior AIDS-defining illness who were in the ICU for greater than 2 weeks, 0/16 survived to hospital discharge (95% CI 0-19%). Patient characteristics not associated with survival included age, gender, race, HIV risk group, insurance status, and severity of illness on admission to the hospital (alveolar-arterial oxygen difference, albumin, and total lymphocyte count.) There was no association between number of days from hospital admission to ICU admission and survival to discharge. Hospital characteristics associated with lower survival of patients cared for in an ICU included increased HIV experience of the hospital and a teaching affiliation. Patients cared for at hospitals with high HIV-experience and teaching affiliation were less likely to receive care in an ICU.

CONCLUSIONS: Increased length of stay in an ICU is associated with decreased survival. However, unlike prior reports, survival for patients in the ICU greater than 2 weeks was not 0, but 24%. Patients with a prior AIDS-defining illness had a low chance of surviving to discharge after ICU care greater than 2 weeks, but small numbers limit prediction. Hospital characteristics were associated with survival after ICU care; these differences likely represent different ICU utilization patterns.

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TuB111

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