A prognostic scoring tool for identification of patients at high and low risk of death from HIV-associated Pneumocystis jirovecii pneumonia

Abstract

A prognostic scoring tool (PST) was created to aid prediction of outcome from HIV-associated Pneumocystis jirovecii pneumonia (PCP) using data obtained from 577 episodes of PCP among 540 patients presenting to a specialist HIV treatment centre in London, UK. It used risk factors identifiable at/soon after hospitalization, previously identified as being associated with mortality: repeat episode of PCP, patient's age, haemoglobin (Hb) and oxygen partial pressure (PaO(2)) on admission, presence of medical co-morbidity (Comorb) and of pulmonary Kaposi sarcoma (PKS). The derived PST was 25.5+(age in years/10) + 2 (if a repeat episode of PCP) + 3 (if Comorb present) + 4 (if PKS detected) - PaO(2) (kPa) - Hb (g/dL), and produced scores that ranged between 0 and 19. Patients were divided into five groups according to their prognostic score: 0-3.9 = group 1 (0% mortality), 4-7.9 = group 2 (3% mortality), 8-10.9 = group 3 (9% mortality), 11-14.9 = group 4 (29% mortality) and ≥ 15 = group 5 (52% mortality). This PST facilitates rapid identification of patients early in their hospitalization who have mild or severe HIV-associated PCP and who are at high and low risk of in-hospital death from PCP. The PST may aid assessment of severity of illness and in directing treatment strategies, but requires validation in patient cohorts from other health-care institutions.

Risk factors for mortality from pneumocystis carinii pneumonia (PCP) in non-HIV patients: a meta-analysis

“…Our results are consistent with previous data for HIV-positive patients that mortality was influenced by respiratory failure, high lactate dehydrogenase, low serum albumin, concomitant bacterial infection, and a need for mechanical ventilation [ 4 , 6 , 7 , 22 – 24 ]. Many other findings in this meta-analysis were novel and deserve further discussion.…”

“…In our study, the pooled overall mortality for non-HIV patients with PCP was 30.6%, which was significantly higher than previously reported mortality rate in HIV-positive patients. The present data confirms the results of previous studies that HIV-negative patients with PCP have different prognosis from the HIV-positive ones [ 7 , 13 , 24 ]. There are several possible explanations for the poorer outcomes in non-HIV PCP.…”

Clinical and Immunologic Predictors of Death After an Acute Opportunistic Infection: Results from ACTG A5164

“…There are few recent data evaluating clinical risk factors for death during an acute OI in the developed world and recently published studies still often include patients treated in the pre-ART era 13,14 . Our results are consistent with earlier studies in PCP and cryptococcal meningitis that showed that markers of more advanced HIV disease such as low albumin 15 , hemoglobin 16,17 , and total lymphocyte count 18 predicted mortality.…”

Pneumocystis jiroveciiGenotype Associated with Increased Death Rate of HIV-infected Patients with Pneumonia

“…An association of this comorbidity factor with an increased risk for death has already been reported ( 24 , 25 ). Several other clinical parameters were reported to be predictors for death caused by PCP in HIV-infected patients ( 26 ), and a scoring tool was recently proposed ( 27 ). Host polymorphisms within receptors involved in the immune response have also been reported to be related to P. jirovecii infection ( 28 , 29 ).…”