Determinants of Short- and Long-term Outcome in Patients With Respiratory Failure Caused by AIDS-Related Pneumocystis carinii Pneumonia

Abstract

Objectives: To determine (1) predictors of in-hospital mortality and long-term survival in patients with acute respiratory failure (ARF) caused by acquired immunodeficiency syndrome-related Pneumocystis carinii pneumonia (PCP) and (2) long-term survival for patients with ARF relative to those without ARF.Methods: A retrospective medical chart review was conducted of all cases of PCP-related ARF for which the patient was admitted to the intensive care unit of a single tertiary care institution between 1991 and 1996. Data were extracted regarding physiologic scores, relevant laboratory values, and duration of previous maximal therapy with combined anti-PCP agents and corticosteroids at entry to the intensive care unit. Duration of survival was determined by Kaplan-Meier methods from date of first hospital admission and compared for patients with and without ARF.Results: There were 41 admissions to the intensive care unit among 39 patients, with 56.4% in-hospital mortality. Higher physiologic scores (Acute Physiology and Chronic Health Evaluation II [APACHE II], Acute Lung Injury, and modified Multisystem Organ Failure scores) were predictive of in-hospital mortality. Duration of previous maximal therapy also predicted in-hospital mortality (45% for patients with Ͻ5 days of previous maximal therapy vs 88% for those with Ն5 days of previous maximal therapy; P = .03). Combining physiologic scores and duration of previous maximal therapy enhanced prediction of in-hospital mortality. There was no difference in long-term survival between patients with PCP with ARF and those without ARF (P = .80), and baseline characteristics did not predict long-term survival.Conclusions: In-hospital mortality of patients with acquired immunodeficiency syndrome-related PCP and ARF is predicted by duration of previous maximal therapy and physiologic scores, and their combination enhances predictive accuracy. Long-term survival of patients with ARF caused by PCP is comparable to that of patients with PCP who do not develop ARF, and determinants of in-hospital mortality do not predict longterm survival. Med. 1999;159:741-747 Arch Intern

Pneumocystis cariniiPneumonia in Critically Ill Patients with Malignancy: A Descriptive Study

“…BAL fluid was also evaluated for the presence of opportunistic bacteria, viruses, fungi, other protozoa, and acid-fast bacteria. In the cytology laboratory, BAL fluid was cytocentrifuged ( cells per slide) and stained with 3 10 May-Grünwald-Giemsa stain for cell count determination and for cell typing as well as for identification and quantification of P. carinii.…”

PneumocystisPneumonia in Human Immunodeficiency Virus–infected Adults and Adolescents: Current Concepts and Future Directions

“…102 When hospitalized in the ICU, at least two-thirds of PCP patients need mechanical ventilation, which generally is associated with a high in-hospital mortality. 103 A prospective, case-control study by Confalonieri et al revealed that use of noninvasive positive pressure ventilation (NPPV) avoided intubation in 67% of patients, and avoidance of intubation was associated with a lower incidence of pneumothoraces and improved survival. 104 NPPV might be considered as a firstline therapeutic choice for respiratory failure in AIDS patients with severe PCP.…”

Early Predictors of Mortality from Pneumocystis jirovecii Pneumonia in HIV-Infected Patients: 1985-2006

“…These studies had differing definitions for diagnosis (laboratory-confirmed PCP or "empirical" PCP) and survival (1 or 3 months); in addition, each study examined only a small number of risk factors. By contrast, several single-center studies, each of which describe !150 patients, have identified increasing patient age [8,9], prior receipt of PCP prophylaxis [10], poor oxygenation at hospitalization [11,12], elevated lactate dehydrogenase enzyme levels [13], low hemoglobin [14] and serum albumin [15] levels, bacterial infection [12], cytomegalovirus (CMV) infection [8], neutrophilia in bronchoalveolar lavage (BAL) fluid [16,17], comorbidity [18,19], pneumothorax [20][21][22], and the need for mechanical ventilation [20][21][22] as being associated with death. These studies are inconsistent, because not all of these studies show these factors to be associated with mortality.…”