—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.
—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.
—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)
Bédos J, Chastang C, Lucet J, Kalo T, Gachot B, Wolff M. Early Predictors of Outcome for HIV Patients With Neurological Failure. JAMA. 1995;273(1):35-40. doi:10.1001/jama.1995.03520250051033