Pneumocystis jirovecii Pneumonia in Patients with Nephrotic Syndrome: Application of Lymphocyte Subset Analysis in Predicting Clinical Outcomes

Abstract

Purpose. With immunosuppressants being widely used, Pneumocystis jirovecii pneumonia (PCP) has been increasing and could be life-threatening among HIV-negative patients.is study aimed at identifying prognostic factors of PCP in patients with nephrotic syndrome. Methods. We retrospectively investigated patients with nephrotic syndrome who were diagnosed with PCP. e diagnosis of PCP was based on clinical manifestations, radiological findings, and microbiological confirmatory tests. Predictors of outcome were determined with multivariate logistic regression analysis. Results. A total of 57 patients were included in this study. e PCP mortality was 33.3%, which increased to 48.6% if ICU admission was required and to 60% when mechanical ventilation was needed. e T lymphocyte count and CD4/CD8 ratio independently predicted the outcome of PCP, so did the CD4 + T lymphocyte count (OR, 0.981; 95% CI, 0.967-0.996; p � 0.001). e cut-off value of 71 cells/μl for the CD4 + T lymphocyte count was determined to identify patients with poor prognosis. No association was found between PCP mortality and the type of immunosuppressant used. Conclusions. PCP is a fatal complication among nephrotic syndrome patients receiving immunosuppressive therapy. e CD4 + T lymphocyte count is suggested as an independent predictor of prognosis, which can be used clinically to identify patients with high risk of unfavorable outcomes.

Risk Factors of Mortality From Pneumocystis Pneumonia in Non-HIV Patients: A Meta-Analysis

“…Table 1 details the basic features of the included articles and the results of the bias risk assessment according to the NOS. Of the 19 included studies, 17 used the case-control study design (6)(7)(8)(9)(10)(11)(12)(13)(16)(17)(18)(19)(20)(21)(22)(23)(24) while two used a retrospective cohort design (14,15). Four studies were performed in China (7,18,22,23), four in Korea (10-13), four in Japan (6,9,19,21), one in Taiwan (17), one in Turkey (15), one in Greece (14), one in Israel (8) and three in France (16,20,24).…”

“…Of the 19 included studies, 17 used the case-control study design ( 6 – 13 , 16 – 24 ) while two used a retrospective cohort design ( 14 , 15 ). Four studies were performed in China ( 7 , 18 , 22 , 23 ), four in Korea ( 10 – 13 ), four in Japan ( 6 , 9 , 19 , 21 ), one in Taiwan ( 17 ), one in Turkey ( 15 ), one in Greece ( 14 ), one in Israel ( 8 ) and three in France ( 16 , 20 , 24 ). The sample sizes of these studies ranged from 20 to 173.…”

“…Sex: thirteen studies ( 6 – 10 , 12 , 13 , 15 , 16 , 18 , 21 – 23 ) were included, with 364 and 584 patients in the non-survivor and survivor groups, respectively. The results showed that sex was not a risk factor of mortality from PcP in non-HIV patients (OR 1.02, 95% CI 0.77 to 1.35, P = 0.90; Figure 2B ).…”

“…Invasive ventilation during hospitalization: twelve studies ( 7 , 8 , 10 , 12 , 14 – 16 , 18 , 19 , 21 , 23 , 24 ) were included, with 278 and 571 patients in the non-survivor and survivor groups, respectively. After the heterogeneity test ( I 2 = 54%, P = 0.01), the random-effects model was used.…”

“…A total of 404 papers were obtained for the initial screening. Finally, 19 articles, which met the inclusion criteria, were included (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). The 19 studies included 1,310 patients (485 and 825 in the non-survivor and survivor groups, respectively).…”