Background: Although the use of antiretroviral therapy has led to dramatic declines in AIDS-associated mortality, Pneumocystis pneumonia (PCP) remains a leading cause of death in HIV-infected patients. Objectives: To measure mortality, identify predictors of mortality at time of illness presentation and derive a PCP mortality prediction rule that stratifies patients by risk for mortality. Methods: An observational cohort study with case note review of all HIV-infected persons with a laboratory diagnosis of PCP at San Francisco General Hospital from 1997 to 2006. Results: 451 patients were diagnosed with PCP on 524 occasions. In-hospital mortality was 10.3%. Multivariate analysis identified five significant predictors of mortality: age (adjusted odds ratio (AOR) per 10-year increase, 1.69; 95% CI 1.08 to 2.65; p = 0.02); recent injection drug use (AOR 2.86; 95% CI 1.28 to 6.42; p = 0.01); total bilirubin .0.6 mg/dl (AOR 2.59; 95% CI 1.19 to 5.62; p = 0.02); serum albumin ,3 g/dl (AOR 3.63; 95% CI 1.72-7.66; p = 0.001); and alveolar-arterial oxygen gradient >50 mm Hg (AOR 3.02; 95% CI 1.41 to 6.47; p = 0.004). Using these five predictors, a six-point PCP mortality prediction rule was derived that stratifies patients according to increasing risk of mortality: score 0-1, 4%; score 2-3, 12%; score 4-5, 48%. Conclusions: The PCP mortality prediction rule stratifies patients by mortality risk at the time of illness presentation and should be validated as a clinical tool.
It is unclear whether patients who are unaware of their HIV infection have different severity or outcomes of Pneumocystis pneumonia (PCP) compared to patients who have been previously diagnosed with HIV. In this retrospective observational cohort study of consecutive HIV-infected patients with microscopically diagnosed PCP at San Francisco General Hospital between 1997 and 2006, 121 of 522 patients (23%) were unaware of their HIV infection prior to their diagnosis of PCP. The proportion of patients with concurrently diagnosed HIV and PCP each year remained unchanged during the study period. Patients with newly diagnosed HIV had a significantly higher alveolar-arterial oxygen gradient at presentation (median 51 versus 45 mm Hg, p=0.03), but there were no differences in mortality, frequency of mechanical ventilation, or admission to intensive care compared to patients with previously diagnosed HIV infection. In multivariate analysis, patients who reported a sexual risk factor for HIV infection were more likely to be newly diagnosed with HIV than patients who reported injection drug use as their only HIV risk factor (odds ratio = 3.14, 95% confidence interval 1.59–6.18, p = 0.001). This study demonstrates a continued need for HIV education and earlier HIV testing, particularly in patients with high-risk sexual behavior.
Diffuse parenchymal lung diseases have diverse etiology and treatment often requires individualization taking into consideration comorbidities. Pulmonary hypertension represents one such comorbidity which, when present, worsens prognosis and confounds approach to treatment. Sildenafil is a pulmonary vasodilator, which has recently generated considerable interest for use in patients with diffuse parenchymal lung disease and concomitant pulmonary hypertension. We wondered whether acute administration of oral sildenafil affects the diffusion capacity measurement, which is a tool for serially monitoring patients with diffuse parenchymal lung diseases. Methods: 15 patients with diffuse parenchymal lung disease and pulmonary hypertension (WHO Class III) had diffusion capacity measurements and 6 minute walk test performed before and after receiving sildenafil 20 mg orally. CT scans of the chest were scored to determine burden of interstitial lung disease. Results: The mean change in DLCO after administration of oral sildenafil was-0.26 ± 0.94 ml/min/mmHg (p=0.30) and-0.41 ± 2.84 % predicted (p=0.58). The average 6 minute walk distance at baseline was 363.28 ± 141 meters. After oral administration of sildenafil, 6 minute walk distance was 369 ± 116 meters (p=0.63). No correlation was observed between composite radiology scores and DLCO measurements or change in DLCO and radiology scores (p=0.43 and p=0.17 respectively). Conclusion: We found no acute change in diffusion capacity after a single dose of oral sildenafil in patients with diffuse parenchymal lung disease and pulmonary hypertension.
Diffuse parenchymal lung diseases have diverse etiology and treatment often requires individualization taking into consideration comorbidities. Pulmonary hypertension represents one such comorbidity which, when present, worsens prognosis and confounds approach to treatment. Sildenafil is a pulmonary vasodilator, which has recently generated considerable interest for use in patients with diffuse parenchymal lung disease and concomitant pulmonary hypertension.We wondered whether acute administration of oral sildenafil affects the diffusion capacity measurement, which is a tool for serially monitoring patients with diffuse parenchymal lung diseases.Methods: 15 patients with diffuse parenchymal lung disease and pulmonary hypertension (WHO Class III) had diffusion capacity measurements and 6-minute walk test performed before and after receiving sildenafil 20 mg orally. CT scans of the chest were scored to determine burden of interstitial lung disease. Results:The mean change in DLCO after administration of oral sildenafil was -0.26± 0.94 ml/min/mmHg (p= 0.30) and -0.41± 2.84 % predicted (p=0.58). The average 6minute walk distance at baseline was 1195±407 feet. After oral administration of sildenafil, 6minute walk distance was 1214±383 feet (p=0.63). No correlation was observed between composite radiology scores and DLCO measurements or change in DLCO and radiology scores (p=0.43 and p=0.17 respectively). Conclusion:We found no acute change in diffusion capacity after a single dose of oral sildenafil in patients with diffuse parenchymal lung disease and pulmonary hypertension.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.