Prognostic Analysis of Pneumocystis Jirovecii Pneumonia in Interstitial Lung Disease Patients: A Retrospective Clinical Study

Sun, Yue; Shao, Chen; Huang, Hui; Chen, Ruxuan; Xu, Kai; Li, Mei; Zhang, Xin; Xu, Zuojun

doi:10.3390/diagnostics12122925

Cited by 4 publications

(1 citation statement)

References 39 publications

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“…Although it does not strictly weaken the immune system, it frequently necessitates the use of immunosuppressive treatment, such as high-dose corticosteroids. Some researchers also have recognized idiopathic lung fibrosis as an independent risk factor for PCP [ 35 , 49 – 51 ] and as a risk factor for death from PCP [ 52 ] as observed in the present study (Table 4 ).…”

Section: Discussionsupporting

confidence: 79%

Pneumocystis pneumonia in French intensive care units in 2013–2019: mortality and immunocompromised conditions

Kamel,

Boulain

2024

Ann. Intensive Care

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Purpose The recent epidemiology of Pneumocystis pneumonia (PCP) requiring intensive care unit (ICU) admission and the associated spectrum of immunocompromising conditions are poorly described. Methods We analyzed all adult PCP cases admitted to French ICUs via the French medical database system (PMSI), over the period from 2013 to 2019. Results French ICUs admitted a total of 4055 adult patients with PCP. Among all hospitalized PCP cases, the proportion requiring ICU admission increased from 17.8 in 2014 to 21.3% in 2019 (P < 0.001). The incidence of severe PCP rose from 0.85 in 2013 to 1.32/100,000 adult inhabitants in 2019 (P < 0.0001), primarily due to the proportion of HIV-negative patients that increased from 60.6% to 74.4% (P < 0.0001). Meanwhile, the annual number of severe PCP cases among patients with HIV infection remained stable over the years. In-hospital mortality of severe PCP cases was 28.5% in patients with HIV infection and 49.7% in patients without. Multivariable logistic analysis showed that patients with HIV infection had a lower adjusted risk of death than patients without HIV infection (Odds Ratio [OR]: 0.30, 95% confidence interval [95CI]: 0.17–0.55). Comorbidities or conditions strongly associated with hospital mortality included the patient’s age, Simplified Acute Physiologic Score II, congestive heart failure, coagulopathy, solid organ cancer, and cirrhosis. A vast array of autoimmune inflammatory diseases affected 19.9% of HIV-negative patients. Conclusions The number of PCP cases requiring ICU admission in France has risen sharply. While the yearly count of severe PCP cases in HIV-infected patients has remained steady, this rise predominantly affects cancer patients, with a recent surge observed in patients with autoimmune inflammatory diseases, affecting one in five individuals.

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Section: Discussionsupporting

confidence: 79%

Pneumocystis pneumonia in French intensive care units in 2013–2019: mortality and immunocompromised conditions

Kamel,

Boulain

2024

Ann. Intensive Care

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Prognostic analysis of Pneumocystis jirovecii pneumonia in patients with systemic vasculitides: a retrospective cohort study

Chen,

Shi,

Sun

et al. 2024

Clin Rheumatol

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Objectives Pneumocystis jirovecii pneumonia (PJP) is a serious complication of autoimmune and inflammatory diseases. This study aimed to describe the characteristics of PJP in patients with various systemic vasculitides and explore potential prognostic factors. Method Data on 62 enrolled PJP patients with systemic vasculitis were analyzed. Patients were stratified based on the outcomes. Prognostic factors were investigated using Cox-regression models. Characteristics of patients with and without interstitial lung disease (ILD) were compared. Results Among 62 vasculitis-PJP patients, 48 had anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), with microscopic polyangiitis (MPA) being the most common subtype (28 patients). MPA (HR 4.33, p = 0.001), concomitant aspergillosis (HR 2.68, p = 0.019), and higher D-dimer at PJP diagnosis (HR 1.07, p = 0.004) were independent adverse prognostic factors for overall survival. Stable disease activity of vasculitis was an independent favorable prognostic factor (HR 0.28, p = 0.027). Patients with MPA were older than non-MPA patients (median age: 69 vs. 58 years, p = 0.001); both ILD and fibrotic ILD were more prevalent in MPA patients (ILD: 78.6% vs. 35.3%, p = 0.001; fibrotic ILD: 57.1% vs. 11.8%, p < 0.001). At the diagnosis of PJP, patients with preexisting ILD had higher counts of white cells, lymphocytes, and neutrophils, as well as higher levels of immunoglobulin (Ig) G and IgA, than patients without preexisting ILD. Conclusions MPA was associated with a higher risk of death in patients with vasculitis-PJP, possibly due to a higher prevalence of ILD. In clinical practice, we should pay more attention to the prophylaxis and management of PJP in patients with systemic vasculitis-associated ILD and/or MPA. Key Points• Data from this study showed that MPA was the most common subtype of vasculitis among vasculitis-PJP patients.• Compared with non-MPA patients in this study, patients with MPA were older, had more ILD and fibrotic ILD, and had a poorer prognosis.• In clinical practice, we should pay more attention to the prophylaxis and management of PJP in patients with systemic vasculitis-associated ILD and/or MPA.

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High prevalence of pneumocystis pneumonia in interstitial lung disease: a retrospective study

Liu,

Ji,

Chen

et al. 2023

Infection

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Prognostic Analysis of Pneumocystis Jirovecii Pneumonia in Interstitial Lung Disease Patients: A Retrospective Clinical Study

Cited by 4 publications

References 39 publications

Pneumocystis pneumonia in French intensive care units in 2013–2019: mortality and immunocompromised conditions

Pneumocystis pneumonia in French intensive care units in 2013–2019: mortality and immunocompromised conditions

Prognostic analysis of Pneumocystis jirovecii pneumonia in patients with systemic vasculitides: a retrospective cohort study

High prevalence of pneumocystis pneumonia in interstitial lung disease: a retrospective study

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