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Septic shock in patients with the acquired immunodeficiency syndrome
M Thyrault1, B Gachot, C Chastang
1Infectious Diseases Department, Bichat-Claude Bernard Hospital, Paris, France.
Objective:
To evaluate the prognosis of patients with septic shock admitted to an intensive care unit (ICU), according to their HIV serostatus.
Design:
Retrospective study.
Setting:
Medical ICU of a university hospital.
Patients:
76 patients with septic shock admitted to the same ICU, of whom 28 were HIV positive and 48 were HIV negative.
Measurements And Results:
Severity scores, number and type of organ failures, and survival rates were assessed in the two groups of patients. Glasgow Coma Scale and general severity scores [Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score (SAPS)] were significantly worse in HIV-infected patients. The total number of organ failures was also higher in the HIV-positive group: 3.7 +/- 0.2 vs 3.1 +/- 0.2 in the HIV-negative group (p < 0.001). On day 28, 21 (46%) HIV-negative patients were dead compared to 26 (93%) patients in the HIV-positive group (p < 0.001). In the multivariate analysis, HIV infection was an independent risk factor for mortality, as were the SAPS score, use of mechanical ventilation, and the McCabe score.
Conclusions:
This study reports a considerable excess mortality in HIV-infected patients with septic shock. Although severity of illness was clearly much more pronounced in HIV-positive patients, retroviral infection was independently associated with death. Improving survival in HIV-positive patients with septic shock may require earlier diagnosis and treatment of the causative infection.