Risk Factors for the Mortality of Pneumocystis jirovecii Pneumonia in Non-HIV Patients Who Required Mechanical Ventilation: A Retrospective Case Series Study

Abstract

Background The risk factors for the mortality rate of Pneumocystis jirovecii pneumonia (PCP) who required mechanical ventilation (MV) remained unknown. Methods A retrospective chart review was performed of all PCP patients admitted to our intensive care unit and treated for acute hypoxemic respiratory failure to assess the risk factors for the high mortality. Results Twenty patients without human immunodeficiency virus infection required mechanical ventilation; 19 received noninvasive ventilation; and 11 were intubated. PEEP was incrementally increased and titrated to maintain FIO2 as low as possible. No mandatory ventilation was used. Sixteen patients (80%) survived. Pneumothorax developed in one patient with rheumatoid arthritis (RA). Median PEEP level in the first 5 days was 10.0 cmH2O and not associated with death. Multivariate analysis showed the association of incidence of interstitial lung disease and increase in serum KL-6 with 90-day mortality. Conclusions We found MV strategies to prevent pneumothorax including liberal use of noninvasive ventilation, and PEEP titration and disuse of mandatory ventilation may improve mortality in this setting. Underlying disease of interstitial lung disease was a risk factor and KL-6 may be a useful predictor associated with mortality in patients with RA. These findings will need to be validated in larger studies.

Aetiology and prognostic risk factors of mortality in patients with pneumonia receiving glucocorticoids alone or glucocorticoids and other immunosuppressants: a retrospective cohort study

“… 44 Kotani et al ’s study indicated that interstitial lung disease was a risk factor associated with mortality in patients with PCP who required mechanical ventilation. 45 Our study demonstrated that several factors conveyed a poor prognosis in this patient population, including high-dose glucocorticoid use, persistent lymphocytopenia and interstitial lung disease.…”

Pneumocystispneumonia in the twenty-first century: HIV-infected versus HIV-uninfected patients

“…PcP is emerging as an important infectious disease in HIV-uninfected persons [4,13]. It is estimated that the annual incidence of PcP in this population exceeds 100,000 cases globally, that the case fatality rate is about 50% and that there are more than 50,000 related deaths [49] Mortality remains higher in HIV-uninfected patients than in HIV-infected patients (40%-60% [62,64] and 5%-15% [7,66] respectively), probably due to the higher inflammatory response, the acute presentation of symptoms, the rapid progression to respiratory failure with the need for invasive mechanical ventilation [8] and the different management practices. Mortality in intensive care unit (ICU) is very high for HIV-uninfected patients with PcP.…”

“…However, several studies still report high mortality rates among HIV-uninfected patients probably due to the greater intensity of the inflammatory response, the acuteness of symptoms, the more frequent progression to respiratory failure requiring tracheal intubation [8], and also the influence of different management practices [9][10][11][12][13].…”

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

“…As such, age may be found to be a significant risk factor for mortality when more patients are analyzed going forward. 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].…”