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

Wang, Yuqiong; Zhou, Xiaoyi; Saimi, Maidinuer; Huang, Xu; Sun, Ting; Fan, Guohui; Zhan, Qingyuan

doi:10.3389/fpubh.2021.680108

Cited by 24 publications

(16 citation statements)

References 55 publications

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“…Coinfection with aspergillosis, honeycombs in the chest HRCT, invasive ventilation and noninvasive ventilation were signi cantly independent risk factors for non-survival in the ILD-PJP patients. The application of mechanical ventilation, a decreased serum albumin, coinfection with aspergillosis or CMV, and an underlying chronic pulmonary disease were reported as poor prognostic factors for PJP patients [4,5,20,36]. Few studies have focused on the brosing characteristics in chest CTs within PJP patients.…”

Section: Discussionmentioning

confidence: 99%

“…A higher serum lactate dehydrogenase (LDH), age, coinfection with cytomegalovirus (CMV), lower peripheral lymphocytes, pneumomediastinum, invasive ventilation, etc. 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].…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 99%

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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“…It remains a severe disease associated with a high mortality rate among patients either positive or negative for human immunodeficiency virus (HIV) infection ( Roux et al, 2014 ; Alanio et al, 2016 ). While the incidence of PCP among HIV-positive patients has declined with the widespread use of antiretroviral and prophylactic therapy ( Morris et al, 2004 ; Salzer et al, 2018 ), PCP has become more frequent in HIV-negative populations in recent years due to the increasing prevalence of immunosuppressive conditions such as hematological malignancies, solid tumors, systemic corticosteroid and immunosuppressive therapies, organ transplantation, and hematopoietic stem cell transplantation ( Jin et al, 2021 ; Wang et al, 2021 ). PCP has been reported to be associated with mortality rates as high as 10%–20% in HIV and 30%–60% in non-HIV patients ( Cilloniz et al, 2019 ).…”

Section: Introductionmentioning

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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“…Conversely, the increasing incidence of PCP in non-HIV immunocompromised patients in recent decades is due to allogeneic bone marrow or organ transplantation, malignancies, corticosteroids, or other immunosuppressive drugs for inflammatory diseases [8]. Non-HIV immune-vulnerable patients with PCP infection are at significant risk of morbidity and mortality [8]. In the United States, the incidence of Pneumocystis pneumonia in HIV-infected individuals has dramatically decreased during the era of antiretroviral therapy (ART).…”

Section: Introductionmentioning

confidence: 99%

Exploring the Differences in Pneumocystis Pneumonia Infection Between HIV and Non-HIV Patients

Nasr¹,

Mohammad²,

Hor³

et al. 2022

Cureus

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Pneumocystis pneumonia (PCP) is one of the most common opportunistic infections worldwide that affects the lung. Pneumocystis leads to pneumonia, caused by Pneumocystis jirovecii, formerly known as Pneumocystis carinii. In recent decades, PCP has been a major health problem for human immunodeficiency virus (HIV) patients and is responsible for most of mortality and morbidity. However, the increasing number of immunosuppressive-related diseases has led to outbreaks in other patient populations, raising the concern for PCP as it becomes a major concern among those patients. These changes led to marked changes in the prevalence and mortality rates of PCP. Huge variations in those parameters among HIV and non-HIV patients have been seen also. Historically, the diagnosis was made by staining and direct visualization of the organism within the bronchoalveolar lavage (BAL) fluid. The diagnosis is now made by microscopic examination and a real-time polymerase chain reaction (PCR) of BAL. Serum (1,3)-β-D-glucan, which is a component of the Pneumocystis jirovecii cell wall that distinguishes it from other fungi, has become an important diagnostic tool. Early diagnosis and treatment play a vital role in the patient's survival and in the infection outcome; hence, empirical PCP therapy should be started immediately when the infection is suspected without waiting for the results of the diagnostic test. Steroids play an important role in the treatment of HIV patients, especially patients who present with hypoxia and respiratory failure. Prophylaxis is very effective and should be given to all patients at high risk of PCP. Antiretroviral therapy (ART) should be started as soon as possible in newly diagnosed HIV-infected patients with PCP, and the immune status of immunocompromised patients with PCP should be improved by temporarily withholding immunosuppressive drugs or reducing their doses.

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

Cited by 24 publications

References 55 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

Exploring the Differences in Pneumocystis Pneumonia Infection Between HIV and Non-HIV Patients

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