Prognostic Factors and Life Expectancy of Patients with Acquired Immunodeficiency Syndrome and<i>Pneumocystis carinii</i>Pneumonia

Brenner, Matthew; Fp, Ognibene; Ee, Lack; Jt, Simmons; Suffredini, A. F.; Hc, Lane; As, Fauci; Je, Parrillo; Jh, Shelhamer; Masur, Henry

doi:10.1164/ajrccm/136.5.1199

Cited by 151 publications

(31 citation statements)

References 3 publications

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“…There is evidence that PCP by itself limits the alveolar endocapillary diffusion for O 2 , possibly related to a large reduction in the membrane diffusing capacity of the alveoli [26]. Direct evidence confirming our hypothesis comes from one study that found a correlation between the severity of interstitial oedema and the prognosis of the patients with PCP [7].…”

Section: Discussionsupporting

confidence: 69%

“…Mortality of severe PCP is around 60% [3,4]. Prognostic factors of outcome for this subset of the population have been investigated in some clinical studies [5][6][7][8]. Established predictors of acute and long-term survival of patients with AIDS and PCP have been based on information obtained at the initial clinical presentation [7].…”

Section: A Ae Et Ti Io Ol Lo Og Gy Y a An Nd D P Pr Ro Og Gn No Os Stmentioning

confidence: 99%

“…Prognostic factors of outcome for this subset of the population have been investigated in some clinical studies [5][6][7][8]. Established predictors of acute and long-term survival of patients with AIDS and PCP have been based on information obtained at the initial clinical presentation [7]. Among these predictors are alveolar-arterial oxygen tension gradient (A-aPO 2 ), Acute Physiology and Chronic Health Evaluation (APACHE) score, severity of chest radiographic abnormalities, and lactate dehydrogenase (LDH) serum levels [5][6][7][8].…”

Section: A Ae Et Ti Io Ol Lo Og Gy Y a An Nd D P Pr Ro Og Gn No Os Stmentioning

confidence: 99%

“…Established predictors of acute and long-term survival of patients with AIDS and PCP have been based on information obtained at the initial clinical presentation [7]. Among these predictors are alveolar-arterial oxygen tension gradient (A-aPO 2 ), Acute Physiology and Chronic Health Evaluation (APACHE) score, severity of chest radiographic abnormalities, and lactate dehydrogenase (LDH) serum levels [5][6][7][8]. A recent study by WACHTER et al [9] using stepwise logistic regression demonstrated that ICU admission era (after 1985) and albumin levels were the only variables associated with survival of AIDS patients with PCP admitted to an ICU.…”

Section: A Ae Et Ti Io Ol Lo Og Gy Y a An Nd D P Pr Ro Og Gn No Os Stmentioning

confidence: 99%

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Aetiology and prognostic factors of patients with AIDS presenting life-threatening acute respiratory failure

Torres

El-Ebiary²,

Marrades³

et al. 1995

Eur Respir J

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Respiratory failure is a significant contributor to morbidity and mortality in patients with the acquired immune deficiency syndrome (AIDS). We performed a study to investigate the aetiology, prognostic factors, and short- and long-term outcome of AIDS patients with life-threatening respiratory failure and pulmonary infiltrates. Forty-two AIDS patients (29 of whom required mechanical ventilation), admitted to a Respiratory Intensive Care Unit (ICU) from 1985 to 1992 because of severe respiratory failure (arterial oxygen tension/fractional inspiratory oxygen (Pa,O2/FI,O2) ratio at hospital admission 19 +/- 14 kPa (mean +/- SD)) and diffuse pulmonary infiltrates, were studied for evaluation of the aetiology and outcome. Necropsy studies were performed in 14 out of 23 (61%) patients who died. Pneumocystis carinii was the most common aetiology of pulmonary infiltrates (28 patients (67%)). Overall, 19 patients survived (45%) and 23 (55%) died. A multivariate analysis of prognostic factors influencing the outcome of the whole population showed that the presence of P. carinii pneumonia and the requirement for mechanical ventilation (MV) were the major determinants of outcome for this type of patient. The median survival time after ICU discharge for P. carinii pneumonia patients was lower (49 days) when compared to that of the remaining patients (154 days). Median survival time after ICU discharge for patients needing MV (112 days) did not differ from that observed in patients not requiring artificial ventilatory support (154 days). Although the ICU survival rate in this study was reasonable, 55% for the whole population, and 36% for P. carinii pneumonia patients, the poor outcome after ICU discharge, in particular for P. carinii pneumonia patients, deserves the reassessment of ICU admission criteria for this type of AIDS population.

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Section: Discussionsupporting

confidence: 69%

Section: A Ae Et Ti Io Ol Lo Og Gy Y a An Nd D P Pr Ro Og Gn No Os Stmentioning

confidence: 99%

Section: A Ae Et Ti Io Ol Lo Og Gy Y a An Nd D P Pr Ro Og Gn No Os Stmentioning

confidence: 99%

Section: A Ae Et Ti Io Ol Lo Og Gy Y a An Nd D P Pr Ro Og Gn No Os Stmentioning

confidence: 99%

See 2 more Smart Citations

Aetiology and prognostic factors of patients with AIDS presenting life-threatening acute respiratory failure

Torres

El-Ebiary²,

Marrades³

et al. 1995

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…There was also no difference in mean lymphocyte counts and CD4-cell counts, with late failures revealing lower levels as compared to patients without prophylaxis as well as to early failures. P(A-a),O 2 as the variable most closely associated with the severeity of PCP [18] was not significantly different between the groups. Severe hypoxaemia defined as an P(A-a),O 2 >8 kPa (>60 mmHg) at presentation was observed in only a minority of cases (17% in the group without any prophylaxis, 0% in the early failure group, and 21% in the late failure group).…”

Section: Clinical Immunological and Laboratory Characteristicsmentioning

confidence: 64%

Effect of long-term primary aerosolized pentamidine prophylaxis on breakthrough Pneumocystis carinii pneumonia

Ewig¹,

Schäfer²,

Rockstroh³

et al. 1996

Eur Respir J

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Aerosolized pentamide is a well-tolerated primary prophylaxis regimen for Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected patients. It is now commonly administered for prolonged periods. We therefore studied the effect of long-term inhalation on breakthrough PCP.We recorded clinical, immunological, radiological and microbiological data, as well as therapy and clinical course of all episodes with confirmed PCP diagnosed at our institution between January 1, 1990 and June 30, 1995. Furthermore, data of all patients on primary aerosolized pentamidine since May 1, 1989 were retrieved. Prophylaxis failures were subdivided into "early" (≤12 months of inhalation time) and "late" (>12 months of inhalation time) failures and were compared with episodes without any prophylaxis.Thirty patients without any prophylaxis, six with early and 14 with late failures represented the study population. Mean±SD inhalation times were 4.9±4.8 and 26.3±14.1 months, respectively. No significant differences could be detected with regard to clinical presentation, severity of PCP, and in-hospital as well as long-term outcome. Early as well as late prophylaxis failures had a higher incidence of upper lobe infiltrates on chest radiography (50% without prophylaxis versus 100% with early and 83% with late failure, respectively; p<0.05). No extrapulmonary or disseminated pneumocystosis was observed in either group. The sensitivity of sitedirected bronchoalveolar lavage was conserved after long-term inhalation (86% versus 100% without prophylaxis and 97% in early failure; p=NS).The severity and outcome of Pneumocystis carinii pneumonia is not altered by long-term primary aerosolized pentamidine prophylaxis. Presentation with upper lobe infiltrates is a radiographic pattern also of late failures. Bronchoalveolar lavage should, therefore, be performed using the site-directed technique in this setting.

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

Forrest¹,

Zala²,

Djurdjev³

et al. 1999

Arch Intern Med

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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

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Prognostic Factors and Life Expectancy of Patients with Acquired Immunodeficiency Syndrome andPneumocystis cariniiPneumonia

Cited by 151 publications

References 3 publications

Aetiology and prognostic factors of patients with AIDS presenting life-threatening acute respiratory failure

Aetiology and prognostic factors of patients with AIDS presenting life-threatening acute respiratory failure

Effect of long-term primary aerosolized pentamidine prophylaxis on breakthrough Pneumocystis carinii pneumonia

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

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