Clinical features and prognostic predictors in patients with rheumatic diseases complicated by Pneumocystis pneumonia

Huang, Yaoxin; Lu, Cheng‐Hsun; Cheng, Colin C.J.; Shen, Chieh-Yu; Hsieh, Song-Chou; Li, Ko-Jen; Chien, Jung-Yien; Hsueh, Po‐Ren

doi:10.1016/j.ijid.2022.07.070

Cited by 3 publications

(4 citation statements)

References 42 publications

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“…The data collection period was from February, 10, 2022 to March, 31, 2023. The primary endpoint of this study was 90-day all-cause mortality, based on previous studies [ 21 , 26 , 31 , 32 ].…”

Section: Methodsmentioning

confidence: 99%

“…These drugs are well-established as therapy for HIV-PcP patients, blunting the inflammatory response induced by anti-pneumocystis treatment, preventing respiratory decompensation failure, and decreasing mortality [17,18]. However, in non-HIV patients, early addition of corticosteroids to anti-pneumocystis therapy was not associated with improved survival outcomes [19][20][21][22][23][24][25][26]. Furthermore, it has even been reported that high steroid doses at diagnosis [27] or long-term pre-onset steroids [28,29] were predictors of poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Pneumocystis jirovecii pneumonia mortality risk associated with preceding long-term steroid use for the underlying disease: A multicenter, retrospective cohort study

Miyake,

Senoo,

Shiiba

et al. 2024

PLoS ONE

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Objective Long-term steroid use increases the risk of developing Pneumocystis pneumonia (PcP), but there are limited reports on the relation of long-term steroid and PcP mortality. Methods Retrospective multicenter study to identify risk factors for PcP mortality, including average steroid dose before the first visit for PcP in non-human immunodeficiency virus (HIV)-PcP patients. We generated receiver operating characteristic (ROC) curves for 90-day all-cause mortality and the mean daily steroid dose per unit body weight in the preceding 10 to 90 days in 10-day increments. Patients were dichotomized by 90-day mortality and propensity score-based stabilized inverse probability of treatment weighting (IPTW) adjusted covariates of age, sex, and underlying disease. Multivariate analysis with logistic regression assessed whether long-term corticosteroid use affected outcome. Results Of 133 patients with non-HIV-PcP, 37 died within 90 days of initial diagnosis. The area under the ROC curve for 1–40 days was highest, and the optimal cutoff point of median adjunctive corticosteroid dosage was 0.34 mg/kg/day. Past steroid dose, underlying interstitial lung disease and emphysema, lower serum albumin and lower lymphocyte count, higher lactate dehydrogenase, use of therapeutic pentamidine and therapeutic high-dose steroids were all significantly associated with mortality. Underlying autoimmune disease, past immunosuppressant use, and a longer time from onset to start of treatment, were associated lower mortality. Logistic regression analysis after adjusting for age, sex, and underlying disease with IPTW revealed that steroid dose 1–40 days before the first visit for PcP (per 0.1 mg/kg/day increment, odds ratio 1.36 [95% confidence interval = 1.16–1.66], P<0.001), low lymphocyte counts, and high lactate dehydrogenase revel were independent mortality risk factor, while respiratory failure, early steroid, and sulfamethoxazole/trimethoprim for PcP treatment did not. Conclusion A steroid dose before PcP onset was strongly associated with 90-day mortality in non-HIV-PcP patients, emphasizing the importance of appropriate prophylaxis especially in this population.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pneumocystis jirovecii pneumonia mortality risk associated with preceding long-term steroid use for the underlying disease: A multicenter, retrospective cohort study

Miyake,

Senoo,

Shiiba

et al. 2024

PLoS ONE

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show abstract

Section: Methodsmentioning

confidence: 99%

“…Adult patients (age 18 years and older) diagnosed with non-HIV-PcP between August 1, 2010, and August 31, 2022, were included in the retrospective review of medical records at seven Japanese sites. The primary endpoint of this study was 90-day all-cause mortality, based on previous studies [21,26,31,32].The study was approved by the Institutional Ethics Committee of National Hospital Organization Himeji Medical Center (No. 2020-28) and all other participating hospitals.The data were analyzed anonymously.…”

mentioning

confidence: 99%

Pneumocystis jiroveciipneumonia mortality risk associated with preceding long-term steroid use for the underlying disease: a multicenter, retrospective cohort study

Miyake,

Senoo,

Shiiba

et al. 2023

Preprint

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ObjectiveLong-term steroid use increases the risk of developing Pneumocystis pneumonia (PcP), but there are limited reports on the relation of long-term steroid and PcP mortality.MethodsRetrospective multicenter study to identify risk factors for PcP mortality, including average steroid dose before the first visit for PcP in non-human immunodeficiency virus (HIV)-PcP patients. We generated receiver operating characteristic (ROC) curves for 90-day all-cause mortality and the mean daily steroid dose per unit body weight in the preceding 10 to 90 days in 10-day increments. Patients were dichotomized by 90-day mortality and propensity score-based stabilized inverse probability of treatment weighting (IPTW) adjusted covariates of age, sex, and underlying disease. Multivariate analysis with logistic regression assessed whether long-term corticosteroid use affected outcome.ResultsOf 133 patients with non-HIV-PcP, 37 died within 90 days of initial diagnosis. The area under the ROC curve for 1-40 days was highest, and the optimal cutoff point of median adjunctive corticosteroid dosage was 0.34 mg/kg/day. Past steroid dose, underlying interstitial lung disease and emphysema, lower serum albumin and lower lymphocyte count, higher lactate dehydrogenase, use of therapeutic pentamidine and therapeutic high-dose steroids were all significantly associated with mortality.Underlying autoimmune disease, past immunosuppressant use, and a longer time from onset to start of treatment, were associated lower mortality. Logistic regression analysis after adjusting for age, sex, and underlying disease with IPTW revealed that steroid dose 1-40 days before the first visit for PcP (per 0.1 mg/kg/day increment, odds ratio 1.36 [95% confidence interval = 1.16-1.66],P<0.001), low lymphocyte counts, and high lactate dehydrogenase revel were independent mortality risk factor, while respiratory failure, early steroid, and sulfamethoxazole/trimethoprim for PcP treatment did not.ConclusionA steroid dose before PcP onset was strongly associated with 90-day mortality in non-HIV-PcP patients, emphasizing the importance of appropriate prophylaxis especially in this population.

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Clinical significance of mutations in dihydropteroate synthase in Pneumocystis jirovecii pneumonia among non-HIV-infected patients

Liao,

Huang,

Lee

et al. 2024

International Journal of Antimicrobial Agents

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Clinical features and prognostic predictors in patients with rheumatic diseases complicated by Pneumocystis pneumonia

Cited by 3 publications

References 42 publications

Pneumocystis jirovecii pneumonia mortality risk associated with preceding long-term steroid use for the underlying disease: A multicenter, retrospective cohort study

Pneumocystis jirovecii pneumonia mortality risk associated with preceding long-term steroid use for the underlying disease: A multicenter, retrospective cohort study

Pneumocystis jiroveciipneumonia mortality risk associated with preceding long-term steroid use for the underlying disease: a multicenter, retrospective cohort study

Clinical significance of mutations in dihydropteroate synthase in Pneumocystis jirovecii pneumonia among non-HIV-infected patients

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