Prognostic value of C-reactive protein in HIV-infected patients with Pneumocystis jirovecii pneumonia

Abstract

C-reactive protein (CRP) is a sensitive marker of inflammation and tissue damage. We aimed to describe CRP responses in HIV-infected patients presenting with Pneumocystis pneumonia (PCP), bacterial pneumonia (BP) and pulmonary tuberculosis (TB) and, in patients with PCP, to identify if elevated CRP has prognostic significance. Data obtained by case-note review of consecutive HIV-infected adults with acute respiratory episodes included admission CRP (elevated >5 mg/L), haemoglobin, white blood count, CD4 count and partial pressure of oxygen in the blood (PaO(2)), presence of pulmonary co-pathology/intercurrent infection and outcome (survival). Median (range) CRP in patients with BP = 120 mg/L (<5-620 mg/L), TB = 44 mg/L (<5-256.3 mg/L) and PCP = 35 mg/L (<5-254 mg/L). CRP was elevated in 93/103 (90.3%) patients with PCP; six patients died; and all had an elevated CRP. PaO(2) and CRP values were associated as follows: average CRP levels declined by 10% (95% confidence interval [CI] 0.20%) per kPa increase in PaO(2) = 0.002. Factors associated with death were higher CRP, odds ratio (OR) (95% CI) = 5.30 (1.61 to 17.51) per 100 mg/L increase, P = 0.006 and haemoglobin, OR (95% CI) = 0.52 (0.29 to 0.93) per g/dL, P = 0.033. CRP is elevated in the majority of HIV-infected patients with PCP, BP and TB. Admission CRP measurement lacks specificity, but in PCP elevations of CRP are associated with disease severity (PaO(2)) and poor outcome and might be used prognostically, together with other mortality risk factors; further prospective evaluation is needed.

Prognostic Value of Bronchoalveolar Lavage in Patients with Non-HIV Pneumocystis Pneumonia

“…According to the univariate logistic regression analysis, various factors described in previous reports, including age, renal transplantation, PaO2/FiO2, mechanical ventilation and the levels of albumin, LDH and CRP, were found to be predictive of mortality (2,3,4,21) in the present study, in addition to BALF neutrophilia. However, in the multivariate analysis, BALF neutrophilia was identified to be the only prognostic factor for non-HIV PCP in patients with a severe respiratory condition.…”

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

“…'by the bedside', which have previously been identified as being associated with mortality from PCP: a repeat episode of PCP, the patient's age, their haemoglobin (Hb), PaO 2 (breathing room air), both on admission; the presence of medical co-morbidity, such as lymphoma or pregnancy, and the presence of PKS. 8 Admission CRP was not included in the model, as despite recent identification of this as a prognostic marker in PCP, 18 data were available in only 105 of the 592 episodes.…”

Plasma IL-6/IL-10 Ratio and IL-8, LDH, and HBDH Level Predict the Severity and the Risk of Death in AIDS Patients withPneumocystisPneumonia

“…CRP and LDH have been evaluated in the diagnosis of AIDS PCP and prediction of PCP severity [4, 5] but have been found to have low predictive value. Since cytokine responses differ for different types of infections, therefore specific patterns of cytokine response may have diagnostic and prognostic value [6].…”