Risk factors for mortality from pneumocystis carinii pneumonia (PCP) in non-HIV patients: a meta-analysis

Abstract

The number of patients with non-human immunodeficiency virus (HIV) related pneumocystis carinii pneumonia (PCP) is increasing with widespread immunosuppressive treatment. We performed a meta-analysis to describe the clinical characteristics and factors associated with outcomes of PCP in HIV-negative patients. A total of 13 studies including 867 patients with non-HIV related PCP was included. The overall mortality for non-HIV patients with PCP was 30.6%. The most common underlying disorder for the development of PCP is hematological malignancies (29.1%), followed by autoimmune disease (20.1%), organ or bone marrow transplantation (14.0%), and solid tumors (6.0%). Risk factors associated with increased mortality rate including old age, female sex, longer time from onset of symptoms to diagnosis, respiratory failure, solid tumors, high lactate dehydrogenase, low serum albumin, bacterial, and aspergillus co-infection, etc (P < 0.05). Adjunctive corticosteroid and PCP prophylaxis was not shown to improve the outcome of PCP in non-HIV patients (P > 0.05). Our findings indicate that mortality in non-HIV patients with PCP is high. Improved knowledge about the prognostic factors may guide the early treatment.

Risk Factors for Mortality in <b><i>Pneumocystis jirovecii</i></b> Pneumonia in Patients with Inflammatory Bowel Disease

“…The difference in mean serum albumin between patients who died and patients who survived was −0.39 (95% CI −0.49 to −0.28; p < 0.001), demonstrating that mean serum albumin was significantly lower in patients who died [16]. This suggests the validity of the equation for prognostic prediction that we obtained through this study.…”

“…Early detection of PJP has been identified as a favorable prognostic factor, and death can be avoided by early diagnosis [16]. However, we did not evaluate the effects of early diagnosis of PJP in this study.…”

“…A multivariate analysis of PJP mortality in patients who had received a kidney transplant or had chronic rheumatoid arthritis or systemic lupus erythematosus showed that development of respiratory failure and percent increase in serum KL-6 were related to 90-day mortality [15]. In a recent review article, age and development of respiratory failure, among other factors, were identified as poor prognostic factors in PJP patients without HIV infection [16]. The 5 patients who died in our study were all on mechanical ventilation within 1 week after PJP onset and had rapidly progressing respiratory failure.…”

Pulmonary Diseases in Refugees and Migrants in Europe

“…In severe HIV-positive cases, adjunct corticosteroids are recommended. The role of corticosteroids in non-HIV patients remains unclear, with a recent meta-analysis showing no benefit [71], and they should not be prescribed routinely in patients with respiratory failure [72]. Alternative treatment regimens include pentamidine, primaquine + clindamycin, atovaquone, or dapsone + trimethoprim [68, 72].…”

The Effects of Sex and Strain onPneumocystis murinaFungal Burdens in Mice

“…Strikingly, there was but a single publication in the PubMed database that compared PCP outcomes in men and women with HIV in 1987 showing women were more likely than men to die in the hospital from PCP [7]. A more recent meta-analysis showed an increase of PCP in nonimmunodeficiency virus (HIV) infected patients, where being a female non-HIV patient was a risk factor, resulting in an increased mortality rate in female vs male non-HIV patients [8].…”