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ADULT RESPIRATORY DISTRESS SYNDROME (ARDS): COMPARISON BETWEEN HIV POSITIVE AND HIV NEGATIVE/UNKNOWN PATIENTS–DETERMINANTS OF OUTCOME IN AN INNER CITY HOSPITAL

Bronx-Lebanon Hospital Center, Bronx, NY

PURPOSE: Implementation of lung protective strategies and fluid restriction has been shown to improve outcome in ARDS. Reported predictors of mortality include age, etiology of ARDS and HIV status among others.The objective of the study is to compare etiology and determinants of outcome for ARDS in HIV positive and HIV negative/unknown patients.

METHODS: Retrospective review of hospitalized patients with ARDS from 2005 to 2007.P value less than 0.05 was considered significant.

RESULTS: We identified 53 patients, mean age 51 years, 30 and 23 in the HIV positive and negative/unknown groups respectively. The 30 HIV patients had AIDS as per CDC definition. Out of the other 23 patients, 6 were HIV negative, 4 had normal CD4 counts and the remaining 13 patients had no HIV test or CD4 cells available-they had no risk factor for HIV infection. There were no statistically significant differences between the two groups for demographics, co-morbid conditions other than HIV status,mortality,severity of illness and lung Injury scores. Plateau pressures were <35cmH2O in both groups.There was statistically significant difference in the tidal volume (TV) used between the groups, mean TV in the HIV negative was 6cc/kg versus 7.4cc/kg in the HIV positive. Exclusion of the HIV unknown patients did not change the results of the analysis. Table 1- Multivariate comparison analysis of determinants of outcome between survivors and non survivors showed that weight gain(positive fluid balance) was the only statistically significant variable associated with poor outcome, p 0.01 Table 2.

CONCLUSION: We did not find HIV status to be a determinant of outcome in our ARDS patients.Low TV ventilatory strategy was seen more often in the HIV negative/unknown group. Our study support the data that weight gain(positive fluid balance)is a predictive factor for mortality in ARDS patients.

CLINICAL IMPLICATIONS: HIV status should not be a consideration when treating and implementing lung protecting strategies in ARDS patients.Fluid balance should be monitored and maintained in ARDS.

DISCLOSURE: Chukwuma Ogugua, No Financial Disclosure Information; No Product/Research Disclosure Information