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Clinical outcome and predictors of survival in patients with pneumocystis jirovecii pneumonia – results of a tertiary referral centre

Authors


  • Author contributions
  • Roembke F and Heinzow HS contributed equally to this work; Roembke F: design of the study, analysis and interpretation of data, drafting of the manuscript; Heinzow HS: analysis and interpretation of data, drafting of the manuscript, technical and material support; Achim Heinecke: supervision of statistical analysis; Gosseling T: acquisition and analysis of data; Domagk D: critical revision of the manuscript for important intellectual content, technical support; Domschke W: revision of the manuscript for important intellectual content; Meister T: senior author, study concept and design, analysis and interpretation of data, drafting of the manuscript, statistical analysis, study supervision, final approval of the version to be published.
  • Ethics
  • The present study has been reviewed by the local ethics committee and has been performed in accordance with the ethical standards laid down in the 2000 Declaration of Helsinki.
  • Conflict of interest
  • The authors have stated explicitly that there are no conflicts of interest in connection with this article.
  • Financial support
  • None.
  • Potential competing interests
  • None.

Abstract

Background and Aims

Pneumocystis jirovecii pneumonia also known as pneumocystis pneumonia (PCP) is an opportunistic respiratory infection in human immunodeficiency virus (HIV) patients that may also develop in non-HIV immunocompromised persons. The aim of our study was to evaluate mortality predictors of PCP patients in a tertiary referral centre.

Methods

Fifty-one patients with symptomatic PCP were enrolled in the study. The patients had either HIV infection (n = 21) or other immunosuppressive conditions (n = 30). Baseline characteristics (e.g. age, sex and underlying disease) were retrieved. Kaplan–Meier analysis was employed to calculate survival. Comparisons were made by log-rank test. A multivariate analysis of factors influencing survival was carried out using the Cox regression model. Chi-squared test and Wilcoxon–Mann–Whitney test was applied as appropriate.

Results

The median survival time for the HIV group was >120 months compared with 3 months for the non-HIV group (P = 0.009). Three-month survival probability was also significantly greater in the HIV group compared with the non-HIV group (90% vs 41%, P = 0.002). In univariate log-rank test, intensive care unit (ICU) necessity, HIV negativity, age >50 years, haemoglobin <10g/dl, C-reactive protein >5 mg/dL and multiple comorbidities were significant negative predictors of survival. In the Cox regression model, ICU and HIV statuses turned out to be independent prognostic factors of survival.

Conclusion

PCP is a serious problem in non-HIV immunocompromised patients in whom survival outcomes are worse than those in HIV patients.

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