Prognostic role of early blood gas variables in critically ill patients with Pneumocystis jirovecii pneumonia: a retrospective analysis

IF 8.8 1区 医学 Q1 CRITICAL CARE MEDICINE
Anouk Voutaz, Jean Bonnemain, Zied Ltaief, Oriol Manuel, Lucas Liaudet
{"title":"Prognostic role of early blood gas variables in critically ill patients with Pneumocystis jirovecii pneumonia: a retrospective analysis","authors":"Anouk Voutaz, Jean Bonnemain, Zied Ltaief, Oriol Manuel, Lucas Liaudet","doi":"10.1186/s13054-024-05087-8","DOIUrl":null,"url":null,"abstract":"<p><i>Pneumocystis jirovecii</i> pneumonia (PJP) is a severe fungal opportunistic infection occurring in immunocompromised patients, commonly associated with Human Immunodeficiency Virus (HIV) in the past and nowadays increasingly diagnosed in non-HIV patients with immune suppression. Severe PJP requiring admission to the intensive care unit is associated with mortality rates &gt; 50%, and several factors have been associated with reduced survival including age, a non-HIV status, invasive mechanical ventilation and the admission SOFA score [1, 2]. Whether additional prognostic factors might help identify high-risk patients at an early stage of ICU stay remains undefined. To address this issue, we retrospectively analyzed (study protocol approved by our ethical committee, CER-VD Nr 2020-00201) the clinical and early (admission—day 0- and day 1) arterial blood gas (ABG) variables, including values of methemoglobin (MetHb) and carboxyhemoglobin (HbCO), in a cohort of PJP patients admitted to our multidisciplinary ICU between 2006 and 2019. The primary outcome was mortality at day 60. Data were compared between survivors and non survivors using the Wilcoxon’s rank sum test and the Pearson’s chi-squared test, and univariate logistic regression analyses were done to evaluate associations between variables and 60-day mortality. We also performed a multivariable analysis incorporating invasive mechanical ventilation at day 1 as a possible confounder, with blood gas data at day 1 (PaCO<sub>2</sub>, HbCO and MetHb) as explanatory co-variables. The impact of blood gas variables on 60-day survival was further assessed using Kaplan–Meier plots and log-rank test analysis.</p><p>A total of 37 patients with confirmed <i>Pneumocystis jirovecii</i> infection (except in one patient in whom no sample could be obtained, but with typical clinical/radiological presentation and a positive beta-glucan test) were included. Underlying diagnoses were malignancy (n = 21), chronic immune-mediated inflammatory disease (n = 8), HIV (n = 5), solid organ (n = 4) or bone marrow transplantation (n = 5), with more than 1 condition present in 6 patients. Most patients had been treated prior to admission with one or more immune suppressive therapies. The 60-day mortality was 51% (19/37 patients). Non-survivors were significantly older but did not differ from survivors with respect to gender and underlying diagnoses. All patients received non-invasive and/or invasive respiratory support, and non-survivors required significantly more often invasive mechanical ventilation (79 vs. 39%, <i>p</i> &lt; 0.05). ABG analyses showed that non-survivors had higher PaCO<sub>2</sub> (day 1), lower pHa and higher MetHb as well as a trend for higher HbCO (day 0 and day 1). In contrast, P/F O<sub>2</sub> was comparable in survivors and non-survivors at the two time-points. In univariate analyses, day 0 HbCO and MetHb, and day 1 PaCO<sub>2</sub>, pHa and MetHb were significantly associated with 60-day mortality (Fig. 1A). In multivariable analysis, PaCO<sub>2</sub> and MetHb at day 1 remained significantly associated with 60-day mortality (Fig. 1B). Kaplan–Meier analyses showed that patients with higher MetHb and lower pHa at day 0 (not shown), as well as higher HbCO, PaCO<sub>2</sub> and MetHb, as well as lower pHa at day 1 (Fig. 1C) had significantly shorter survival.</p><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><picture><source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05087-8/MediaObjects/13054_2024_5087_Fig1_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"927\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs13054-024-05087-8/MediaObjects/13054_2024_5087_Fig1_HTML.png\" width=\"685\"/></picture><p>Arterial blood gas data at day 0 and day 1. <b>A</b> P/FO<sub>2</sub>, PaCO<sub>2</sub>, pHa, HbCO and MetHb at day 0 and day 1 in survivors and non-survivors (median, interquartile rage) and their univariate association with 60-day mortality. <b>B</b> Multivariable analysis of factors associated with 60-day mortality. <b>C</b> Kaplan–Meier plots illustrating the proportion of survivors in the 60-day observation period, as a function of PaCO<sub>2</sub>, (in mmHg), pHa, MetHb and HbCO at day 1, dichotomized according to their median values in the whole cohort. For continuous variables, odds ratios (OR) and 95% confidence intervals (CI) were calculated per unit change (P/FO<sub>2</sub>: 10 mm Hg; PaCO<sub>2</sub>: 1 mm Hg; pHa: 0.01 pH unit; HbCO: 0.1%; MetHb: 0.1%). Note: At day 0, P/FO<sub>2</sub> missing in 1 patient (survivor), HbCO and MetHB not measured in 3 patients (2 survivors, 1 non survivors). At day 1: ABG not obtained in 3 patients (1 non-survivor, 2 survivors), in whom HbCO and MetHb were obtained from central venous blood gas analysis. <i>IMV</i> invasive mechanical ventilation</p><span>Full size image</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>Our study found that several ABG variables obtained during the first 24 h of ICU admission may provide important early prognostic information in patients with PJP. The higher PaCO<sub>2</sub> and lower pHa in non-survivors could either reflect the development of respiratory fatigue or increased dead space ventilation, which would be consistent with the negative impact of higher dead space fraction in other forms of acute respiratory failure [3]. Non-survivors also displayed higher levels of MetHb, whose values at day 0 and day 1 were significantly associated with 60-day mortality. MetHb formed from Hb autooxidation is normally maintained at very low levels due to the activity of MetHb reductase, but may increase in critically ill patients with sepsis, or treated with inhaled NO or prooxidant drugs such as dapsone [4]. Since none of our patients received these therapies at the time of MetHb measurements, we propose that MetHb formation could reflect more severe lung inflammation, favoring a greater pro-oxidant environment fostering hemoglobin oxidation. We also noted, to a lesser extent, that HbCO was higher in non-survivors and that its value at admission was associated with 60-day mortality. Endogenous CO formation results from the activity of heme oxygenase (HO), and pulmonary HO induction has been reported in a variety of lung inflammatory diseases [5]. Therefore, we speculate that the early increase of HbCO in PJP non-survivors could reflect such an induction of HO due to more severe lung inflammation. In summary, we found that, in patients admitted to the ICU for acute respiratory failure due to <i>Pneumocystis jirovecii</i> pneumonia, several early (first 24 h) changes in arterial blood gases present a significant association with 60-day mortality. These include a higher PaCO<sub>2</sub>, a lower arterial pH, higher values of methemoglobin and (to a lesser extent) carboxyhemoglobin. Whether the recognition of these early prognostic variables could alter patient management and result in a better outcome should require further studies.</p><p>All data generated or analyzed during this study are included in this article.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Lecuyer R, Issa N, Camou F, Lavergne RA, Gabriel F, Morio F, et al. Characteristics and prognosis factors of <i>Pneumocystis jirovecii</i> pneumonia according to underlying disease: a retrospective multicenter study. Chest. 2024;165:1319–29.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"2.\"><p>Giacobbe DR, Dettori S, Di Pilato V, Asperges E, Ball L, Berti E, et al. Pneumocystis jirovecii pneumonia in intensive care units: a multicenter study by ESGCIP and EFISG. Crit Care. 2023;27:323.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"3.\"><p>Kallet RH, Zhuo H, Ho K, Lipnick MS, Gomez A, Matthay MA. Lung injury etiology and other factors influencing the relationship between dead-space fraction and mortality in ARDS. Respir Care. 2017;62:1241–8.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"4.\"><p>Belzer A, Krasowski MD. Causes of acquired methemoglobinemia—a retrospective study at a large academic hospital. Toxicol Rep. 2024;12:331–7.</p><p>Article CAS PubMed PubMed Central Google Scholar </p></li><li data-counter=\"5.\"><p>Nagasawa R, Hara Y, Murohashi K, Aoki A, Kobayashi N, Takagi S, et al. Serum heme oxygenase-1 measurement is useful for evaluating disease activity and outcomes in patients with acute respiratory distress syndrome and acute exacerbation of interstitial lung disease. BMC Pulm Med. 2020;20:310.</p><p>Article CAS PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><p>None</p><p>None to declare.</p><h3>Authors and Affiliations</h3><ol><li><p>Service of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland</p><p>Anouk Voutaz, Jean Bonnemain, Zied Ltaief &amp; Lucas Liaudet</p></li><li><p>Service of Infectious Diseases, Faculty of Biology and Medicine, Lausanne University Hospital, University of Lausanne, 1010, Lausanne, Switzerland</p><p>Oriol Manuel</p></li></ol><span>Authors</span><ol><li><span>Anouk Voutaz</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Jean Bonnemain</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Zied Ltaief</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Oriol Manuel</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Lucas Liaudet</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Contributions</h3><p>AV: Experimental design; investigation; data curation; formal analysis; writing: original draft, JB: Formal analysis; writing: review and editing, ZL: Formal analysis; writing: review and editing, OM: Formal analysis; writing: review and editing, LL: Formal analysis; writing: original draft, review and editing.</p><h3>Corresponding author</h3><p>Correspondence to Lucas Liaudet.</p><h3>Ethics approval and consent to participate</h3>\n<p>The study was approved by our local ethical committee (Commission cantonale d'éthique de la recherche sur l’être humain, CER-VD, project number 2020–00201).</p>\n<h3>Consent for publication</h3>\n<p>Not applicable.</p>\n<h3>Competing interests</h3>\n<p>The authors declare no competing interests.</p><h3>Publisher's Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.</p>\n<p>Reprints and permissions</p><img alt=\"Check for updates. 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0-.92-.08-1.33-.25-.41-.16-.77-.4-1.08-.7-.3-.31-.54-.69-.72-1.13-.17-.44-.26-.95-.26-1.52zm4.61-.62c0-.55-.11-.98-.34-1.28-.23-.31-.58-.47-1.06-.47-.41 0-.77.15-1.08.45-.31.29-.5.73-.57 1.3zm3.01 2.23c.31.24.61.43.92.57.3.13.63.2.98.2.38 0 .65-.08.83-.23s.27-.35.27-.6c0-.14-.05-.26-.13-.37-.08-.1-.2-.2-.34-.28-.14-.09-.29-.16-.47-.23l-.53-.22c-.23-.09-.46-.18-.69-.3-.23-.11-.44-.24-.62-.4s-.33-.35-.45-.55c-.12-.21-.18-.46-.18-.75 0-.61.23-1.1.68-1.49.44-.38 1.06-.57 1.83-.57.48 0 .91.08 1.29.25s.71.36.99.57l-.74.98c-.24-.17-.49-.32-.73-.42-.25-.11-.51-.16-.78-.16-.35 0-.6.07-.76.21-.17.15-.25.33-.25.54 0 .14.04.26.12.36s.18.18.31.26c.14.07.29.14.46.21l.54.19c.23.09.47.18.7.29s.44.24.64.4c.19.16.34.35.46.58.11.23.17.5.17.82 0 .3-.06.58-.17.83-.12.26-.29.48-.51.68-.23.19-.51.34-.84.45-.34.11-.72.17-1.15.17-.48 0-.95-.09-1.41-.27-.46-.19-.86-.41-1.2-.68z" fill="#535353"/></g></svg>\" width=\"57\"/><h3>Cite this article</h3><p>Voutaz, A., Bonnemain, J., Ltaief, Z. <i>et al.</i> Prognostic role of early blood gas variables in critically ill patients with <i>Pneumocystis jirovecii</i> pneumonia: a retrospective analysis. <i>Crit Care</i> <b>28</b>, 318 (2024). https://doi.org/10.1186/s13054-024-05087-8</p><p>Download citation<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><ul data-test=\"publication-history\"><li><p>Received<span>: </span><span><time datetime=\"2024-09-03\">03 September 2024</time></span></p></li><li><p>Accepted<span>: </span><span><time datetime=\"2024-09-05\">05 September 2024</time></span></p></li><li><p>Published<span>: </span><span><time datetime=\"2024-09-27\">27 September 2024</time></span></p></li><li><p>DOI</abbr><span>: </span><span>https://doi.org/10.1186/s13054-024-05087-8</span></p></li></ul><h3>Share this article</h3><p>Anyone you share the following link with will be able to read this 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Abstract

Pneumocystis jirovecii pneumonia (PJP) is a severe fungal opportunistic infection occurring in immunocompromised patients, commonly associated with Human Immunodeficiency Virus (HIV) in the past and nowadays increasingly diagnosed in non-HIV patients with immune suppression. Severe PJP requiring admission to the intensive care unit is associated with mortality rates > 50%, and several factors have been associated with reduced survival including age, a non-HIV status, invasive mechanical ventilation and the admission SOFA score [1, 2]. Whether additional prognostic factors might help identify high-risk patients at an early stage of ICU stay remains undefined. To address this issue, we retrospectively analyzed (study protocol approved by our ethical committee, CER-VD Nr 2020-00201) the clinical and early (admission—day 0- and day 1) arterial blood gas (ABG) variables, including values of methemoglobin (MetHb) and carboxyhemoglobin (HbCO), in a cohort of PJP patients admitted to our multidisciplinary ICU between 2006 and 2019. The primary outcome was mortality at day 60. Data were compared between survivors and non survivors using the Wilcoxon’s rank sum test and the Pearson’s chi-squared test, and univariate logistic regression analyses were done to evaluate associations between variables and 60-day mortality. We also performed a multivariable analysis incorporating invasive mechanical ventilation at day 1 as a possible confounder, with blood gas data at day 1 (PaCO2, HbCO and MetHb) as explanatory co-variables. The impact of blood gas variables on 60-day survival was further assessed using Kaplan–Meier plots and log-rank test analysis.

A total of 37 patients with confirmed Pneumocystis jirovecii infection (except in one patient in whom no sample could be obtained, but with typical clinical/radiological presentation and a positive beta-glucan test) were included. Underlying diagnoses were malignancy (n = 21), chronic immune-mediated inflammatory disease (n = 8), HIV (n = 5), solid organ (n = 4) or bone marrow transplantation (n = 5), with more than 1 condition present in 6 patients. Most patients had been treated prior to admission with one or more immune suppressive therapies. The 60-day mortality was 51% (19/37 patients). Non-survivors were significantly older but did not differ from survivors with respect to gender and underlying diagnoses. All patients received non-invasive and/or invasive respiratory support, and non-survivors required significantly more often invasive mechanical ventilation (79 vs. 39%, p < 0.05). ABG analyses showed that non-survivors had higher PaCO2 (day 1), lower pHa and higher MetHb as well as a trend for higher HbCO (day 0 and day 1). In contrast, P/F O2 was comparable in survivors and non-survivors at the two time-points. In univariate analyses, day 0 HbCO and MetHb, and day 1 PaCO2, pHa and MetHb were significantly associated with 60-day mortality (Fig. 1A). In multivariable analysis, PaCO2 and MetHb at day 1 remained significantly associated with 60-day mortality (Fig. 1B). Kaplan–Meier analyses showed that patients with higher MetHb and lower pHa at day 0 (not shown), as well as higher HbCO, PaCO2 and MetHb, as well as lower pHa at day 1 (Fig. 1C) had significantly shorter survival.

Fig. 1
Abstract Image

Arterial blood gas data at day 0 and day 1. A P/FO2, PaCO2, pHa, HbCO and MetHb at day 0 and day 1 in survivors and non-survivors (median, interquartile rage) and their univariate association with 60-day mortality. B Multivariable analysis of factors associated with 60-day mortality. C Kaplan–Meier plots illustrating the proportion of survivors in the 60-day observation period, as a function of PaCO2, (in mmHg), pHa, MetHb and HbCO at day 1, dichotomized according to their median values in the whole cohort. For continuous variables, odds ratios (OR) and 95% confidence intervals (CI) were calculated per unit change (P/FO2: 10 mm Hg; PaCO2: 1 mm Hg; pHa: 0.01 pH unit; HbCO: 0.1%; MetHb: 0.1%). Note: At day 0, P/FO2 missing in 1 patient (survivor), HbCO and MetHB not measured in 3 patients (2 survivors, 1 non survivors). At day 1: ABG not obtained in 3 patients (1 non-survivor, 2 survivors), in whom HbCO and MetHb were obtained from central venous blood gas analysis. IMV invasive mechanical ventilation

Full size image

Our study found that several ABG variables obtained during the first 24 h of ICU admission may provide important early prognostic information in patients with PJP. The higher PaCO2 and lower pHa in non-survivors could either reflect the development of respiratory fatigue or increased dead space ventilation, which would be consistent with the negative impact of higher dead space fraction in other forms of acute respiratory failure [3]. Non-survivors also displayed higher levels of MetHb, whose values at day 0 and day 1 were significantly associated with 60-day mortality. MetHb formed from Hb autooxidation is normally maintained at very low levels due to the activity of MetHb reductase, but may increase in critically ill patients with sepsis, or treated with inhaled NO or prooxidant drugs such as dapsone [4]. Since none of our patients received these therapies at the time of MetHb measurements, we propose that MetHb formation could reflect more severe lung inflammation, favoring a greater pro-oxidant environment fostering hemoglobin oxidation. We also noted, to a lesser extent, that HbCO was higher in non-survivors and that its value at admission was associated with 60-day mortality. Endogenous CO formation results from the activity of heme oxygenase (HO), and pulmonary HO induction has been reported in a variety of lung inflammatory diseases [5]. Therefore, we speculate that the early increase of HbCO in PJP non-survivors could reflect such an induction of HO due to more severe lung inflammation. In summary, we found that, in patients admitted to the ICU for acute respiratory failure due to Pneumocystis jirovecii pneumonia, several early (first 24 h) changes in arterial blood gases present a significant association with 60-day mortality. These include a higher PaCO2, a lower arterial pH, higher values of methemoglobin and (to a lesser extent) carboxyhemoglobin. Whether the recognition of these early prognostic variables could alter patient management and result in a better outcome should require further studies.

All data generated or analyzed during this study are included in this article.

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Authors and Affiliations

  1. Service of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Anouk Voutaz, Jean Bonnemain, Zied Ltaief & Lucas Liaudet

  2. Service of Infectious Diseases, Faculty of Biology and Medicine, Lausanne University Hospital, University of Lausanne, 1010, Lausanne, Switzerland

    Oriol Manuel

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  3. Zied LtaiefView author publications

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Contributions

AV: Experimental design; investigation; data curation; formal analysis; writing: original draft, JB: Formal analysis; writing: review and editing, ZL: Formal analysis; writing: review and editing, OM: Formal analysis; writing: review and editing, LL: Formal analysis; writing: original draft, review and editing.

Corresponding author

Correspondence to Lucas Liaudet.

Ethics approval and consent to participate

The study was approved by our local ethical committee (Commission cantonale d'éthique de la recherche sur l’être humain, CER-VD, project number 2020–00201).

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Not applicable.

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The authors declare no competing interests.

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Voutaz, A., Bonnemain, J., Ltaief, Z. et al. Prognostic role of early blood gas variables in critically ill patients with Pneumocystis jirovecii pneumonia: a retrospective analysis. Crit Care 28, 318 (2024). https://doi.org/10.1186/s13054-024-05087-8

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肺孢子虫肺炎重症患者早期血气变量的预后作用:回顾性分析
吉罗韦氏肺孢子菌肺炎(PJP)是一种严重的真菌机会性感染,多发于免疫力低下的患者,过去通常与人类免疫缺陷病毒(HIV)有关,如今越来越多的非 HIV 患者因免疫抑制而被诊断为 PJP。需要入住重症监护室的重症 PJP 死亡率高达 50%,有几个因素与存活率降低有关,包括年龄、非 HIV 感染状况、有创机械通气和入院 SOFA 评分[1, 2]。其他预后因素是否有助于在入住 ICU 的早期阶段识别高危患者,目前仍未确定。为了解决这个问题,我们回顾性分析了 2006 年至 2019 年期间入住我们多学科 ICU 的一组 PJP 患者的临床和早期(入院第 0 天和第 1 天)动脉血气(ABG)变量(研究方案已获伦理委员会批准,CER-VD Nr 2020-00201),包括高铁血红蛋白(MetHb)和碳氧血红蛋白(HbCO)的值。主要结果是第 60 天的死亡率。我们使用 Wilcoxon 秩和检验和皮尔逊卡方检验比较了存活者和非存活者之间的数据,并进行了单变量逻辑回归分析,以评估变量与 60 天死亡率之间的关联。我们还进行了多变量分析,将第 1 天的有创机械通气作为可能的混杂因素,并将第 1 天的血气数据(PaCO2、HbCO 和 MetHb)作为解释性共变因素。共纳入 37 名确诊为肺孢子虫感染的患者(除一名患者无法获得样本,但具有典型的临床/放射学表现和β-葡聚糖检测呈阳性外)。基础诊断包括恶性肿瘤(21 例)、慢性免疫介导的炎症性疾病(8 例)、艾滋病(5 例)、实体器官移植(4 例)或骨髓移植(5 例),其中 6 例患者患有一种以上的疾病。大多数患者在入院前曾接受过一种或多种免疫抑制疗法。60天死亡率为51%(19/37名患者)。非幸存者的年龄明显偏大,但在性别和基础诊断方面与幸存者没有差异。所有患者都接受了非侵入性和/或侵入性呼吸支持,非存活者需要侵入性机械通气的比例明显更高(79 比 39%,P &lt;0.05)。ABG 分析显示,非存活者的 PaCO2(第 1 天)较高,pHa 较低,MetHb 较高,HbCO(第 0 天和第 1 天)也呈上升趋势。相比之下,幸存者和非幸存者在两个时间点的 P/F O2 值相当。在单变量分析中,第 0 天的 HbCO 和 MetHb 以及第 1 天的 PaCO2、pHa 和 MetHb 与 60 天死亡率显著相关(图 1A)。在多变量分析中,第 1 天的 PaCO2 和 MetHb 仍与 60 天死亡率显著相关(图 1B)。Kaplan-Meier 分析显示,第 0 天 MetHb 较高和 pHa 较低的患者(图中未显示),以及第 1 天 HbCO、PaCO2 和 MetHb 较高和 pHa 较低的患者(图 1C)生存期明显较短。A 存活者和非存活者在第 0 天和第 1 天的 P/FO2、PaCO2、pHa、HbCO 和 MetHb(中位数,四分位数间差)及其与 60 天死亡率的单变量关系。B 与 60 天死亡率相关因素的多变量分析。C Kaplan-Meier 图显示 60 天观察期内存活者的比例与第 1 天的 PaCO2(单位:mmHg)、pHa、MetHb 和 HbCO 的函数关系,并根据其在整个队列中的中位值进行二分。对于连续变量,计算了每单位变化的几率比(OR)和 95% 置信区间(CI)(P/FO2:10 mmHg;PaCO2:1 mmHg;pHa:0.01 pH 单位;HbCO:0.1%;MetHb:0.1%)。注:第 0 天,1 名患者(存活者)的 P/FO2 缺失,3 名患者(2 名存活者,1 名非存活者)未测量 HbCO 和 MetHB。第 1 天:3 名患者(1 名非存活者,2 名存活者)未获得 ABG,其中 HbCO 和 MetHb 是通过中心静脉血气分析获得的。IMV 有创机械通气全尺寸图片我们的研究发现,在入住 ICU 的头 24 小时内获得的几个 ABG 变量可为 PJP 患者提供重要的早期预后信息。非存活患者较高的 PaCO2 和较低的 pHa 可能反映了呼吸疲劳的发展或死腔通气的增加,这与其他形式的急性呼吸衰竭中较高的死腔分数的负面影响是一致的[3]。非存活者的 MetHb 水平也较高,其第 0 天和第 1 天的值与 60 天死亡率显著相关。
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来源期刊
Critical Care
Critical Care 医学-危重病医学
CiteScore
20.60
自引率
3.30%
发文量
348
审稿时长
1.5 months
期刊介绍: Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.
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