An audit of HIV patients admitted to a multidisciplinary tertiary level intensive care unit

Abstract

Background: South Africa has the largest number of people living with HIV. There is limited data in developing countries on the outcomes of HIV infected patients in the intensive care unit (ICU). The objectives of this study were to describe the pattern of presentation of these patients and to determine factors that may influence survival to ICU discharge. Methods: Medical charts of 204 consecutive HIV infected individuals that were admitted to the Charlotte Maxeke Johannesburg Academic Hospital adult general ICU during the 2017 calendar year were retrospectively reviewed. Relevant data was subjected to univariate and multivariate analysis. Results: Two-hundred and four (22.6%) out of a total of 903 patients that were admitted to the ICU were HIV positive. Sepsis related illnesses was the most common reason for ICU admission, (n=95, 46.6%), followed by post-operative care (n=69, 33.8%) and non-sepsis related illnesses (n=40, 19.6%). The median length of stay in the ICU was 5 (2-9) days. ICU mortality was 33.3% (n=68). On univariate analysis, age (p=0.039), length of stay in ICU (p=0.040), primary diagnostic category (p<0.05), sepsis acquired during ICU stay (p=0.012), requirement for inotropic/vasopressor support (p<0.001), requirement for mechanical ventilation (p<0.001), requirement for haemodialysis (p=0.001), CD4 cell count (p=0.011), APACHE II score (P<0.001) and SOFA score (p<0.001) were significantly associated with mortality. Conclusion: Age, diagnostic category, sepsis acquired during ICU stay, inotrope/vasopressor administration, mechanical ventilation, haemodialysis, CD4 cell count, APACHE II score, SOFA score and length of ICU stay are associated with ICU mortality in HIV infected patients.