Prognostic Factors Affecting Death in Patients with Rheumatoid Arthritis Complicated by Pneumocystis jirovecii Pneumonia and One-Year Clinical Course: The ANSWER Cohort Study

Abstract

This multicenter retrospective study aimed to clarify the prognostic factors for mortality and changes in treatment modalities and disease activities after the onset of Pneumocystis jirovecii pneumonia (PCP) in patients with rheumatoid arthritis (RA). Data regarding the clinical background, treatment modalities, and disease activity indicators of RA at the onset of PCP (baseline), and 6 months and 12 months after treatment were extracted. Of the 37 patients with RA-PCP (median age, 69 years; 73% female), chemical prophylaxis was administered to 8.1%. Six patients died during PCP treatment. The serum C-reactive protein (CRP) levels and the prednisolone (PDN) dose at baseline in the PCP death group were significantly higher than those in the survivor group. Multivariate analysis using a Cox regression model showed that PDN dose at baseline was a predictor of death from PCP in patients with RA. During the 12 months from baseline, the RA disease activity significantly decreased. A high dose of corticosteroids for RA may result in a poor prognosis when PCP is complicated. In the future, preventive administration techniques must be established for patients with RA who need PCP prevention.

Machine Learning Models for Prediction of Severe Pneumocystis carinii Pneumonia after Kidney Transplantation: A Single-Center Retrospective Study

“…Elevated CRP has also been previously reported to be strongly associated with disease severity and death in HIV-infected PCP patients [18]. A multicenter study by Shiba et al on PCP patients with rheumatoid arthritis similarly found that CRP levels at baseline were significantly higher in the PCP mortality group than in the survivor group [19]. Hou et al found that advanced age, high baseline levels of LDH and CRP, and low platelet counts were risk factors for in-hospital mortality in patients with mNGS-positive PCP diagnosed by second-generation sequencing of macrogenomi [20].…”

Risk Factors for Pneumocystis jirovecii Pneumonia in Non-HIV Patients Hospitalized for COVID-19: A Case-Control Study

“…When corticosteroids were withdrawn, the rats gained weight, cleared P. jirovecii from the lungs, and regenerated their lymphoid tissues; the lymphocyte subpopulations exhibited variation in their frequencies at different body sites, but gradually returned to baseline levels [ 27 ]. It would be interesting to know with ad hoc studies if the length or the cumulative steroid dose can also have an impact on the COVID-19-associated PJP outcome, as shown, for example, in the ANSWER cohort study by Shiba and colleagues in patients with rheumatoid arthritis that developed PJP, in which a baseline higher dose of chronic steroid at the time of PJP diagnosis was associated with higher mortality [ 28 ].…”