Neurological complications of HIV infection in critically ill patients: Clinical features and outcomes - 02/08/11
, H. Ferrand a, F. Tubach b, C. Roy b, L. Bouadma a, I.F. Klein c, A. Foucrier a, B. Regnier a, B. Mourvillier a, M. Wolff a
Corresponding author. Tel.: +33 1 40258122; fax: +33 1 40258782.Summary |
Objective |
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.
Le texte complet de cet article est disponible en PDF.Keywords : HIV, Delirium, Seizures, Intracranial hypertension, Toxoplasmosis
Plan
Vol 62 - N° 4
P. 301-308 - avril 2011 Retour au numéro
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