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Article
January 4, 1995

Early Predictors of Outcome for HIV Patients With Neurological Failure

Author Affiliations

From the Infectious Intensive Care Unit, Bichat-Claude Bernard University Hospital, Paris, France (Drs Bédos, Lucet, Kalo, Gachot, and Wolff), and the Department of Biostatistics and Medical Computing, Saint-Louis Hospital, Paris, France (Dr Chastang).

JAMA. 1995;273(1):35-40. doi:10.1001/jama.1995.03520250051033
Abstract

Objective.  —To carry out a descriptive study of human immunodeficiency virus (HIV)—infected patients admitted to an intensive care unit (ICU) with neurological failure and to identify parameters that are predictive of death within 3 months. Design.—Case series study.

Population and Setting.  —A total of 84 consecutive HIV-infected patients admitted to an infectious disease ICU in a university hospital for neurological failure. A thorough clinical, laboratory, and brain computed tomography (CT) scan workup was done within 48 hours of admission.

Main Results.  —The mean (±SD) CD4+ lymphocyte count was 0.067 (±0.086) ×109/L. Mechanical ventilation was necessary within 48 hours of admission in 67 cases (80%). The brain CT scan revealed abscesses in 51 patients (61%). The abscesses were attributed to probable toxoplasmosis in 47 patients. A total of 57 patients died, yielding a 3-month survival rate of 32%. By the log-rank test, the following factors were predictive of death within 3 months of admission to the ICU: Glasgow Coma Scale score less than 7 (P=.01), signs of brain stem involvement (P=.001), and need for mechanical ventilation in the 48 hours after admission (P=.02). In a Cox model, only Glasgow Coma Scale score less than 7 (P=.006) and clinical signs of brain stem involvement (P=.02) were predictive of death within 3 months of admission to the ICU.

Conclusions.  —Despite a thorough examination, no initial HIV-specific parameters were identified as predictive of death. The prognostic factors found simply reflected the severity of neurological involvement in the various etiologies.(JAMA. 1995;273:35-40)

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