Neurological complications of HIV infection in critically ill patients: Clinical features and outcomes
2011; Elsevier BV; Volume: 62; Issue: 4 Linguagem: Inglês
10.1016/j.jinf.2011.02.003
ISSN1532-2742
AutoresRomain Sonneville, H. Ferrand, Florence Tubach, Carine Roy, Lila Bouadma, Isabelle Klein, Arnaud Foucrier, B. Régnier, Bruno Mourvillier, Michel Wolff,
Tópico(s)Infectious Encephalopathies and Encephalitis
ResumoObjective We aimed to investigate the prognosis of HIV-infected patients with acute neurological complications at the highly active antiretroviral therapy (HAART) era. Methods We performed a retrospective study in HIV-infected patients admitted to a medical ICU with neurological complications between 2001 and 2008. Results Among the 210 studied patients (median [interquartile range] CD4-cell count: 80 [18–254]/μL; HIV viral load: 4.8 [2–5.3] log10/mL), 40 (19%) had unknown HIV status at admission. Neurological complications consisted in delirium (45%), coma (39%), seizures (32%) and/or intracranial hypertension (21%). Admission diagnoses were AIDS-defining CNS disease for 88 (42%) patients, non-AIDS-defining CNS disease for 45 (21%), and systemic disease with neurological signs for 77 (37%). Seizures (p=0.003), focal deficit (p<0.001) and intracranial hypertension (p<0.001) were more frequently observed in patients with AIDS-defining CNS disease. Factors independently associated with ICU mortality (29.5%) were intracranial hypertension [odds ratio (OR), 5.09; 95% confidence interval (95% CI), 2.17–11.91], vasopressor use [OR, 3.92; 95% CI, 1.78–8.60] and SAPS II score [per 10-point increment, OR, 1.59; 95% CI, 1.31–1.93]. Conclusions Prognosis of HIV-infected patients with neurological complications depends rather on clinical presentation than on HIV-related parameters. Intracranial hypertension symptoms at admission have a major impact on outcome.
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