Risk Factors for Mortality in &lt;b&gt;&lt;i&gt;Pneumocystis jirovecii&lt;/i&gt;&lt;/b&gt; Pneumonia in Patients with Inflammatory Bowel Disease

Yoshida, Atsushi; Kamata, Noriko; Yamada, Akihiro; Yokoyama, Yoko; Omori, Teppei; Fujii, Toshimitsu; Hayashi, Ryohei; Kinjo, Tetsu; Matsui, Akira; Fukata, Norimasa; Takahashi, Sakuma; Sakemi, Ryosuke; Ogata, Noriyuki; Ashizuka, Shinya; Bamba, Shigeki; Ooi, Makoto; Kanmura, Shuji; Endo, Katsuya; Yoshino, Takayuki; Tanaka, Hiroki; Morizane, Toshio; Shinzaki, Shinichiro

doi:10.1159/000495035

Cited by 10 publications

(22 citation statements)

References 17 publications

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“…The elevation of LDH was shown to be correlated with PCP patients' poor outcome ( 23 ) in the study of Schimdt et al Meanwhile, Yoshida et al found that hypoproteinemia also affects prognosis among PCP patients with inflammatory bowel disease ( 24 ). By comparing the dynamic change of laboratory parameters (PaO 2 /FiO 2 ratio, LDH and NLR, and so on) on day 1, 3, and 7 after admission in the ICU, our study demonstrated a significant different trend between survivors and non-survivors.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Prognostic Factors of Non-HIV Immunocompromised Patients With Pneumocystis Pneumonia Diagnosed by Metagenomics Next-Generation Sequencing

et al. 2022

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ObjectiveThe aim of this study was to evaluate the potential of metagenomic next-generation sequencing (mNGS) for the diagnosis of pneumocystis pneumonia (PCP) in patients with non-human immunodeficiency virus-infection and to discuss the clinical characteristics and identify prognostic factors associated with patients with non-HIV PCP.MethodsForty-six patients with PCP who were admitted in respiratory intensive care unit (ICU) between May 2018 and May 2020 were retrospectively reviewed. The subjects were divided into survivor and non-survivor groups according to the patients' outcome. Conventional methods and mNGS for detecting Pneumocystis jirovecii (P. jirovecii) were analyzed. The patients' demographics, comorbidities, laboratory parameters, and treatments were compared and evaluated in both groups to identify risk factors for mortality by using univariate and multivariate logistic regression.ResultsMetagenomic next-generation sequencing (mNGS) showed a satisfying diagnostic performance of 100% positive of detecting P. jirovecii from bronchoalveolar lavage (BAL) specimens in forty-six patients with non-HIV PCP, compared to only 15.2% for Gomori Methenamine silver (GMS) staining and 84.8% for Serum 1,3-beta-D-glucan (BDG). Among them, the mean age was 46.4-year-old (range 18–79-year-old) and mortality rate was 43.5%. The dominant underlying conditions were connective tissue diseases (34.8%), autoimmune kidney diseases (30.4%), followed by hematologic malignancies (10.9%), and solid organ transplantation (6.5%). A total of 38 cases (82.6%) received glucocorticoid and 19 cases (41.3%) used immunosuppressant within 3 months before diagnosed PCP. Multiple infections were very common, over two thirds' cases had mixed infections. Compared with survivors, non-survivors had a higher acute physiology and chronic health evaluation II (APACHE II) score (14.4 ± 4.8 vs. 10 ± 3.4), Procalcitonin (PCT) [ng/ml: 0.737 (0.122–1.6) vs. 0.23 (0.095–0.35)], lactic dehydrogenase (LDH) [U/L: 1372 (825.5–2150) vs. 739 (490.5–956)], and neutrophil-lymphocyte ratio (NLR) [21.6 (15.67–38.2) vs. 11.75 (5.1–15.52)], but had a lower PaO2/FiO2 ratio (mmHg:108.8 ± 42.4 vs. 150.5 ± 47.5), lymphocytes [×109/L: 0.33 (0.135–0.615) vs. 0.69 (0.325–1.07)] and CD4+ T cells [cell/μl: 112 (53.5–264) vs. 255 (145–303.5)], all P < 0.05. Furthermore, we found non-survivors' PaO2/FiO2 ratio of day 3 and day 7 had not improved when compared with that of day one, and platelet level and NLR became worse. Multivariate analysis showed that other pathogens' co-infection (OR = 9.011, 95% CI was 1.052–77.161, P = 0.045) and NLR (OR = 1.283, 95% CI was 1.046–1.547, P = 0.017) were the independent risk factors of poor prognosis.ConclusionmNGS is a very sensitive diagnostic tool for identifying P. jirovecii in patients who are non-HIV immunocompromised. PCP in patients who are non-HIV infected is associated with a high rate of multiple infections and severe condition. Mixed infection and elevation of NLR were the independent risk factors of poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Characteristics and Prognostic Factors of Non-HIV Immunocompromised Patients With Pneumocystis Pneumonia Diagnosed by Metagenomics Next-Generation Sequencing

et al. 2022

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“…The use of steroids in conjunction with additional immunosuppressant agents has been empirically reported to increase patients’ risk of PCP [ 18 , 26 - 28 ], as well as having an additive lymphopenic effect [ 29 ]. Therefore, it seems possible that the rise of multidrug immunosuppressive therapy regimens, particularly those including corticosteroids, is contributing to an increasing risk of PCP among patients with IBD, as has been previously reported in smaller scale studies [ 18 , 28 , 30 ].…”

Section: Discussionmentioning

confidence: 93%

“…Similarly, we cannot explore the specific immunosuppressive therapies that patients were taking or the duration of their therapy, which would be helpful in tailoring more nuanced prophylaxis recommendations. In addition, we cannot comment on the validity or utility of proposed laboratory monitoring for PCP risk stratification among IBD patients, including T-lymphocyte counts [ 21 ], CD4 counts [ 21 ], and serum albumin levels [ 30 ]. Furthermore, the use of administrative coding poses the risk of diagnostic misclassification, although the use of ICD coding in IBD has been previously validated in a variety of contexts [ 33 - 36 ].…”

Section: Discussionmentioning

confidence: 99%

Comprehensive National Inpatient Sample data reveals low but rising Pneumocystis jiroveci pneumonia risk in inflammatory bowel disease patients

Schwartz¹

2022

aog

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Background There are only limited data to guide the management of infectious risk for Pneumocystis jiroveci pneumonia (PCP) in patients with inflammatory bowel disease (IBD). We evaluated the frequency of admissions for PCP among patients with IBD, as well as the temporal trend in PCP admission rates and the contribution of non-IBD risk factors to the development of infection. Methods The National Inpatient Sample from 2016-2017 was queried for all admissions involving both PCP and either Crohn’s disease or ulcerative colitis. Inpatient outcomes associated with PCP and additive risk factors for development of PCP within the IBD patient population were assessed using multivariate regression. Linear regression was performed on data from 2002-2017 to measure infectious trends over time. Results There were an estimated 225 admissions involving PCP among patients with IBD from 2016-2017 nationwide, representing 0.035% of total admissions. IBD patients with PCP faced a 4.67-fold higher adjusted odds of inpatient mortality (95% confidence interval 1.72-12.66), while 49% of patients with IBD who developed PCP had an unrelated risk factor. The most common factors were HIV and congenital immunodeficiency, both of which were associated with PCP in adjusted regression. The infectious incidence of PCP increased by 141% from 2002 to 2017 (P=0.003). Conclusions National admissions data indicate that significant PCP is rare in IBD patients. Routine PCP prophylaxis is probably not necessary, although further study of high-risk subgroups of patients is required. The rising incidence of PCP indicates a need for continued surveillance.

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“…Hypoalbuminemia is reported as an independent risk factor of mortality in a study performed on HIV patients with PcP infection ( 44 ), and it has also been reported as an independent risk factor for non-HIV ( 45 , 46 ). Albumin has antioxidant activity and can protect the cells from oxidative stress in sepsis.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Zhou

Saimi

et al. 2021

Front. Public Health

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Background: We performed a meta-analysis to systematically review the risk factors of mortality from non-HIV-related Pneumocystis pneumonia (PcP) and provide the theoretical basis for managing non-HIV-related PcP.Methods: PubMed, Embase, Web of Science, the Cochrane Library and CNKI databases were searched. A meta-analysis of the risk factors of mortality from non-HIV-related PcP was conducted.Results: A total of 19 studies and 1,310 subjects were retrieved and included in the meta-analysis, including 485 and 825 patients in the non-survivor and survivor groups, respectively. In the primary analysis, age, concomitant with other pulmonary diseases at diagnosis of PcP, solid tumors, cytomegalovirus(CMV) co-infection, lactate dehydrogenase (LDH), lymphocyte count, invasive ventilation during hospitalization, and pneumothorax were associated with mortality from non-HIV-related PcP, whereas sex, albumin, PcP prophylaxis, use of corticosteroids after admission, and time from onset of symptoms to treatment were not associated with mortality from non-HIV-related PcP.Conclusions: The mortality rate of non-HIV-infected patients with PcP was still high. Age, concomitant with other pulmonary diseases at diagnosis of PcP, solid tumors, CMV co-infection, LDH, lymphocyte count, invasive ventilation during hospitalization, and pneumothorax were risk factors of mortality from non-HIV-related PcP. Improved knowledge of prognostic factors is crucial to guide early treatment.

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Risk Factors for Mortality in <b><i>Pneumocystis jirovecii</i></b> Pneumonia in Patients with Inflammatory Bowel Disease

Cited by 10 publications

References 17 publications

Characteristics and Prognostic Factors of Non-HIV Immunocompromised Patients With Pneumocystis Pneumonia Diagnosed by Metagenomics Next-Generation Sequencing

Characteristics and Prognostic Factors of Non-HIV Immunocompromised Patients With Pneumocystis Pneumonia Diagnosed by Metagenomics Next-Generation Sequencing

Comprehensive National Inpatient Sample data reveals low but rising Pneumocystis jiroveci pneumonia risk in inflammatory bowel disease patients

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

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