Septic shock in patients with the acquired immunodeficiency syndrome

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. Received: 30 September 1996 Accepted: 8 July 1997