Prognostic factors for severe Pneumocystis jiroveci pneumonia of non-HIV patients in intensive care unit: a bicentric retrospective study

Abstract

BackgroundPneumocystis jiroveci pneumonia (PJP) in non-HIV patients is still a challenge for intensivists. The aim of our study was to evaluate mortality predictors of PJP patients requiring Intensive care unit (ICU) admission.MethodsRetrospectively review medical records of patients with diagnosis of PJP admitted to four ICUs of two academic medical centers from October 2012 to October 2015.ResultsEighty-two patients were enrolled in the study. Overall hospital mortality was 75.6 %. Compared with survivors, the non-survivors had older age (55 ± 16 vs. 45 ± 17, p = 0.014), higher APACHE II score (20 ± 5 vs. 17 ± 5, p = 0.01), lower white blood cell count (7.68 ± 3.44 vs. 10.48 ± 4.62, p = 0.005), less fever (80.6%vs. 100 %, p = 0.033), more hypotension (58.1 % vs. 20 %, p = 0.003), more pneumomediastinum (29 % vs. 5 %, p = 0.027). Logistic regression analysis demonstrated that age [odds ratio (OR)1.051; 95 % CI 1.007-1.097; p = 0.022], white blood cell count [OR 0.802; 95 % CI 0.670-0.960; p = 0.016], and pneumomediastinum [OR 16.514; 95 % CI 1.330-205.027; p = 0.029] were independently associated with hospital mortality.ConclusionsMortality rate for non-HIV PJP patients requiring ICU admission was still high. Poor prognostic factors included age, white blood cell count and pneumomediastinum.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1855-x) contains supplementary material, which is available to authorized users.

Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies

“…Malignant disease with chemotherapy, corticosteroids treatment for inflammatory autoimmune diseases, and transplantation of solid organs or bone marrow are the leading causes of T cell suppression, which is associated with a high risk of opportunistic infections, including PCP [1,2]. The mortality associated with PCP in the non-HIV population group remains high, ranging from 19 to 76% [3][4][5], despite the availability of effective antimicrobial agents such as trimethoprim/sulfamethoxazole (TMP-SMZ) and pentamidine.…”

Pneumocystis pneumonia in patients with primary nephrotic syndrome: analysis of 18 cases

“…Among HIV-negative PCP patients, studies indicate that most have hematological or solid malignancies, connective tissue diseases (CTD) or organ transplantation, and only a few patients have primary nephrotic syndrome (PNS) [8][9][10]. Patients with PNS have defective cell-mediated immunity, and steroid or immunosuppressive therapy causes immunologic dysfunction, which also leads to increased susceptibility to infection [11,12].…”

Etiologies and Outcomes of Rheumatology Patients with Acute Respiratory Failure Requiring Intensive Care: A Single-Center Cohort Study of 259 Patients

“…Despite different immunological mechanisms and clinical manifestations, rheumatology patients are often characterized by chronic inflammation, multiorgan involvement, and acute exacerbation (flareup) [1,2]. Among all hospitalized rheumatology patients, up to one third need admission to intensive care unit (ICU) [1] while mortality rates are highly variable (from 16-80%), depending on underlying systemic rheumatic diseases (SRDs), reasons of ICU admission, severity of acute illness, and organ involvement/dysfunction [3][4][5][6][7][8][9][10][11][12].…”