Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases

Ishikawa, Yuichi; Nakano, Kazuhisa; Tokutsu, Kei; Miyata, Hiroko; Fujino, Yoshihisa; Matsuda, Shinya; Tanaka, Yoshiya

doi:10.1136/rmdopen-2020-001508

Cited by 18 publications

(15 citation statements)

References 35 publications

(32 reference statements)

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“…A low peripheral lymphocyte percentage (< 20%) was common in both the ILD-PJP and non-ILD-PJP groups (89.5% vs. 85.2%). The lymphocyte percentage and the absolute lymphocyte count were [(9.4 ± 7.8)% vs. (11.7 ± 10.9)%] and [(0.79 ± 0.82) ×10 9 /L vs. (0.86 ± 0.89) ×10 9 /L] for the ILD-PJP vs. non-ILD-PJP groups, respectively. There were 94 patients/70.7% with ILD-PJP and 150 patients/61.5% with non-ILD-PJP who had lymphocytopenia.…”

Section: Resultsmentioning

confidence: 99%

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Prognostic analysis of Pneumocystis jirovecii pneumonia in interstitial lung disease patients: a retrospective clinical study

Sun

Shao

Huang

et al. 2022

Preprint

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Background Pre-exiting chronic lung disease was a poor prognostic factor for pneumocystis jiroveci pneumonia (PJP). However, the clinical characteristics and the prognostic factors of HIV negative PJP patients (non-HIV-PJP) with interstitial lung disease (ILD) remains unclear. Methods This was a retrospective study of hospitalized patients with confirmed PJP and ILD at Peking Union Medical College Hospital between January 2014 and December 2020. The enrolled patients were stratified based on the presence or absence of ILD and the presence of fibrotic ILD (FILD) or nonfibrotic ILD (non-FILD). The log-rank test and Cox regression models were used to analyze the prognostic factors for PJP patients with different pre-existing statuses. Results Among 836 hospitalized individuals with PJP, there were 378 non-HIV-PJP with complete clinical-radiological-follow-up data. Among them, there were 133cases (35.2%) with non-HIV-ILD-PJP, and 70 patients were classified as fibrotic ILD-PJP. The all-cause mortality rate for ILD-PJP group was higher than that of non-ILD-PJP group (57.9% vs 38.4%, Log-rank = 12.2, p < 0.001, However, the all-cause mortality was similar between FILD-PJP and non-FILD-PJP (Log-rank = 0.03, p > 0.05). Co-infection with aspergillosis(HR = 2.89, χ2 = 5.0, p = 0.02, 95%CI:1.14–7.28), honeycomb in the chest HRCT(HR = 16.3, χ2 = 16.8, p < 0.001, 95%CI:4.3–62), invasive ventilation(HR = 3.02, χ2 = 7.1, p < 0.01, 95%CI:1.34–6.82) and non- invasive ventilation(HR = 6.2, χ2 = 16.7, p < 0.001, 95%CI:2.58–14.9 ) were independent survival risk factors for non-HIV-ILD-PJP. Non-invasive ventilation support (HR = 928.56, χ2 = 7.3, p < 0.01, 95%CI:6.6-130796.5) and the serum D-dimer (HR = 1.2, χ2 = 10.9, p < 0.001, 95%CI:1.01–1.34) were independent survival risk factors for fibrotic ILD-PJP patients. Conclusions Pre-exiting ILD is independently associated with poor survival of PJP patients. Co-infection with aspergillosis, honeycomb in the chest HRCT, invasive ventilation and non- invasive ventilation were independent survival risk factors for ILD patients complicated with PJP.

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Section: Resultsmentioning

confidence: 99%

“…have been reported to be associated risk factors for mortality in non-HIV-PJP patients [3][4][5][6]. Pre-existing chronic lung disease, especially interstitial lung disease (ILD), is a poor prognostic factor for PJP patients [7][8][9]. Corticosteroids and/or immunosuppressants are common medications for most ILD patients.…”

Section: Introductionmentioning

confidence: 99%

Prognostic analysis of Pneumocystis jirovecii pneumonia in interstitial lung disease patients: a retrospective clinical study

Sun

Shao

Huang

et al. 2022

Preprint

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“…Another bicentric retrospective study also suggested that age (OR 1.051 [95% CI 1.007–1.097]) was an independent risk factor for hospital mortality for non-HIV patients in the intensive care unit, although its effect was only slight. Old age has been consistently correlated with worse prognosis in patients with connective tissue disease-associated PCP ( Ishikawa et al, 2021 ). In the present study, multivariate logistic regression analysis confirmed that age was independently associated with the risk for IMV (OR 2.615 [95% CI 1.110–6.159]), indicating that older PCP patients are more likely to require IMV during hospitalization.…”

Section: Discussionmentioning

confidence: 99%

A Clinically Applicable Nomogram for Predicting the Risk of Invasive Mechanical Ventilation in Pneumocystis jirovecii Pneumonia

Wan

Bai

Yan

et al. 2022

Front. Cell. Infect. Microbiol.

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ObjectivePneumocystis jirovecii pneumonia (PCP) is a life-threatening disease associated with a high mortality rate among immunocompromised patient populations. Invasive mechanical ventilation (IMV) is a crucial component of treatment for PCP patients with progressive hypoxemia. This study explored the risk factors for IMV and established a model for early predicting the risk of IMV among patients with PCP.MethodsA multicenter, observational cohort study was conducted in 10 hospitals in China. Patients diagnosed with PCP were included, and their baseline clinical characteristics were collected. A Boruta analysis was performed to identify potentially important clinical features associated with the use of IMV during hospitalization. Selected variables were further analyzed using univariate and multivariable logistic regression. A logistic regression model was established based on independent risk factors for IMV and visualized using a nomogram.ResultsIn total, 103 patients comprised the training cohort for model development, and 45 comprised the validation cohort to confirm the model’s performance. No significant differences were observed in baseline clinical characteristics between the training and validation cohorts. Boruta analysis identified eight clinical features associated with IMV, three of which were further confirmed to be independent risk factors for IMV, including age (odds ratio [OR] 2.615 [95% confidence interval (CI) 1.110–6.159]; p = 0.028), oxygenation index (OR 0.217 [95% CI 0.078–0.604]; p = 0.003), and serum lactate dehydrogenase level (OR 1.864 [95% CI 1.040–3.341]; p = 0.037). Incorporating these three variables, the nomogram achieved good concordance indices of 0.829 (95% CI 0.752–0.906) and 0.818 (95% CI 0.686–0.950) in predicting IMV in the training and validation cohorts, respectively, and had well-fitted calibration curves.ConclusionsThe nomogram demonstrated accurate prediction of IMV in patients with PCP. Clinical application of this model enables early identification of patients with PCP who require IMV, which, in turn, may lead to rational therapeutic choices and improved clinical outcomes.

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“…It was expected that using the ICD-10 codes alone would identify patients who were not treated for HZ as well as those suspected with HZ who initiated treatment. To ensure robust diagnosis, we enrolled cases who received HZ-specific antivirals for at least 7 days, the standard duration of HZ treatment (25,26). The principal diagnosis of underlying diseases was recorded using the following ICD-10 codes: malignancies, C00-C98; solid cancer, C00-C80, C97; malignant lymphoma and hematopoietic malignancies, C81-C96; human immunodeficiency virus disease, B20-B24; immunodeficiencies, D80-D84; Transplanted organ and tissue status, Z94; disorders of the thyroid gland, E05.1, E06.3; diabetes mellitus (DM); E10-E14; dyslipidemia, E78; hyperuricemia, E79.0, M10; depressive disorder, F31-F34; demyelinating diseases, G35-G37; chronic obstructive pulmonary disease (COPD), J44; asthma, J45; interstitial lung disease (ILD), J84, J99.0, J99.1; hypertension (HT) and HT-related diseases, I10-I15; heart failure (HF), I11.0, I13.0, I50, I97.1; chronic ischemic heart disease (cIHD), I25; sequelae of cerebrovascular disease (CVD), I69; inflammatory bowel diseases, K50 and K51; autoimmune hepatitis, K75.…”

Section: Definition Of Hz and Underlying Diseasesmentioning

confidence: 99%

“…Therefore, the diagnosis may uncertain. However, the diagnostic accuracy of DPC is moderate or high (43,44), and previous studies using database have also used the ICD codes (25,32). We used information on antivirals for HZ to improve diagnostic accuracy.…”

Section: Limitationsmentioning

confidence: 99%

Short-Term Prognostic Factors in Hospitalized Herpes Zoster Patients and Its Associated Cerebro-Cardiovascular Events: A Nationwide Retrospective Cohort in Japan

et al. 2022

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BackgroundShort-term mortality and incidence of cerebrovascular and cardiovascular events (C-CVE) during hospitalization of patients with severe herpes zoster (HZ) have not been sufficiently investigated. We aimed to investigate short-term prognosis and incidence of C-CVE associated with HZ in hospitalized patients.MethodsThis retrospective cohort study from April 2016 to March 2018 included HZ inpatient cases selected from the Diagnosis Procedure Combination database—a Japanese nationwide inpatient database. HZ and C-CVE were diagnosed based on the 10th revision of the International Classification of Diseases and Injuries codes. The definition of primary exposure was that treatments were initiated within 7 days of admission, and antivirals were administered for ≥7 days. Main Outcomes were in-hospital deaths and C-CVE onset after hospitalization.ResultsAmong 16,811,501 in-hospital cases registered from 1,208 hospitals, 29,054 cases with HZ were enrolled. The median age was 71.0 years, 15,202 cases (52.3%) were female, and the HZ types were the central nervous system (n=9,034), disseminated (n=3,051), and ophthalmicus (n=1,069) types. There were 301 (1.0%) in-hospital deaths and 385 (1.3%) post-hospitalization onset of C-CVE. The 30-day in-hospital survival rates with or without underlying disease were 96.8% and 98.5%, respectively. Age ≥75 years (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.55–3.05), liver cirrhosis or hepatic failure (HR, 5.93; 95% CI, 2.16–16.27), chronic kidney disease (HR, 1.82; 95% CI, 1.24–2.68), heart failure (HR, 1.65; 95% CI, 1.22–2.24), and old cerebrovascular events (HR, 1.92; 95% CI, 1.10–3.34) were associated with poor short-term prognosis. Age ≥75 years (odds ratio [OR], 1.70; 95% CI, 1.29–2.24), diabetes (OR, 1.50; 95% CI, 1.19–1.89), dyslipidemia (OR, 1.95; 95% CI, 1.51–2.51), hyperuricemia (OR, 1.63; 95% CI, 1.18–2.27), hypertension (OR, 1.76; 95% CI, 1.40–2.20), heart failure (OR, 1.84; 95% CI, 1.32–2.55), and glucocorticoid administration (OR, 1.59; 95% CI, 1.25–2.01) were associated with increased risks for in-hospital C-CVE onset.ConclusionsThe underlying diseases that could influence the short-term mortality of severe HZ were identified. Glucocorticoid is a possible risk factor for the in-hospital onset of C-CVE after severe HZ development.

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Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases

Cited by 18 publications

References 35 publications

Prognostic analysis of Pneumocystis jirovecii pneumonia in interstitial lung disease patients: a retrospective clinical study

Prognostic analysis of Pneumocystis jirovecii pneumonia in interstitial lung disease patients: a retrospective clinical study

A Clinically Applicable Nomogram for Predicting the Risk of Invasive Mechanical Ventilation in Pneumocystis jirovecii Pneumonia

Short-Term Prognostic Factors in Hospitalized Herpes Zoster Patients and Its Associated Cerebro-Cardiovascular Events: A Nationwide Retrospective Cohort in Japan

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