Human immunodeficiency virus infection and hospital mortality in acute lung injury patients

To evaluate the impact of human immunodeficiency virus infection on hospital mortality in patients with acute lung injury and to evaluate predictors of mortality among acute lung injury patients with human immunodeficiency virus.

Retrospective study of human immunodeficiency virus-infected patients enrolled in an ongoing prospective cohort study of acute lung injury patients conducted at 13 intensive care units in four teaching hospitals in Baltimore, Maryland.

Of 520 consecutive acute lung injury patients, 66 (13%) were human immunodeficiency virus-positive. In human immunodeficiency virus-positive vs. human immunodeficiency virus-negative patients, pneumonia was the most common acute lung injury risk factor (43 [65%] vs. 184 [41%]; p=.001), and the median (interquartile range) Acute Physiology and Chronic Health Evaluation II score was modestly higher (27 [22-33] vs. 26 [20-33]; p=.06). There was no difference in crude hospital mortality (44% vs. 46%; p=.78) between human immunodeficiency virus-positive and human immunodeficiency virus-negative acute lung injury patients. After adjustment for potential confounders, human immunodeficiency virus infection was not an independent predictor of hospital mortality (odds ratio, 1.39; 95% confidence interval, 0.69-2.78; p=.35). In the human immunodeficiency virus-infected acute lung injury patients, among 23 relevant measures of intensive care unit and human immunodeficiency virus severity of illness, only the presence of an opportunistic infection before hospital admission was independently associated with hospital mortality (odds ratio, 6.4; 95% confidence interval, 1.27-32.3; p=.025).

In patients with acute lung injury, human immunodeficiency virus-positive patients had similar hospital mortality as human immunodeficiency virus-negative patients; hence, human immunodeficiency virus status should not influence estimates of short-term prognosis for acute lung injury patients in the intensive care unit. Among human immunodeficiency virus-positive patients with acute lung injury, the presence of a previous opportunistic infection, rather than traditional measures of severity of illness, may be most strongly predictive of hospital mortality.