Daniele Roberto Giacobbe, Silvia Dettori, Vincenzo Di Pilato, Erika Asperges, Lorenzo Ball, Enora Berti, Ola Blennow, Bianca Bruzzone, Laure Calvet, Federico Capra Marzani, Antonio Casabella, Sofia Choudaly, Anais Dartevel, Gennaro De Pascale, Gabriele Di Meco, Melissa Fallon, Louis-Marie Galerneau, Miguel Gallego, Mauro Giacomini, Adolfo González Saez, Luise Hänsel, Giancarlo Icardi, Philipp Koehler, Katrien Lagrou, Tobias Lahmer, Philip Lewis White, Laura Magnasco, Anna Marchese, Cristina Marelli, Mercedes Marín Arriaza, Ignacio Martin-Loeches, Armand Mekontso-Dessap, Malgorzata Mikulska, Marco Muccio, Alessandra Mularoni, Anna Nordlander, Julien Poissy, Giovanna Russelli, Alessio Signori, Carlo Tascini, Louis-Maxime Vaconsin, Joel Vargas, Antonio Vena, Joost Wauters, Paolo Pelosi, Jean-Francois Timsit, Matteo Bassetti
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引用次数: 0
Abstract
Background: Pneumocystis jirovecii pneumonia (PJP) is a life-threatening disease. In the intensive care unit (ICU), PJP is most frequently observed among patients with several conditions not related to the human immunodeficiency virus (HIV) infection.
Methods: The primary objective of the present post-hoc analysis of a multicenter, multinational, retrospective study was to assess factors impacting prognosis in ICU patients with PJP through univariable and multivariable analyses.
Results: A total of 107 patients were included; 28 had proven PJP (26.2%), and 79 had presumptive PJP (73.8%). The overall 30-day mortality was 52.7% (95% confidence interval [CI] 42.1-62.2). In the multivariable analysis, metastatic solid tumor (hazard ratio [HR] 3.49; 95% CI 1.71-7.13, p < 0.001) and chronic liver disease (HR 2.44; 95% CI 1.03-5.80, p = 0.044) showed an independent association with 30-day mortality. The direction of effect remained consistent when center was added to the multivariable model as random effect.
Conclusion: PJP mortality remains high in ICU patients. Conditions other than HIV infection are emerging not only as non-classical risk factors for PJP development, but also as important mortality predictors. A better understanding of the reasons underlying this evolving landscape could be crucial to improve PJP management and survival.
背景：耶氏肺囊虫肺炎（PJP）是一种危及生命的疾病。在重症监护室（ICU）， PJP最常见于与人类免疫缺陷病毒（HIV）感染无关的几种疾病的患者。方法：本多中心、多国、回顾性研究的主要目的是通过单变量和多变量分析来评估影响PJP ICU患者预后的因素。结果：共纳入107例患者；确诊PJP 28例（26.2%），推定PJP 79例（73.8%）。总30天死亡率为52.7%（95%可信区间[CI] 42.1-62.2）。在多变量分析中，转移性实体瘤(风险比[HR] 3.49；95% CI 1.71-7.13, p p = 0.044)显示与30天死亡率独立相关。将中心作为随机效应加入多变量模型时，效应方向保持一致。结论：PJP在ICU患者中的死亡率仍然很高。艾滋病毒感染以外的其他疾病不仅是PJP发展的非经典危险因素，而且也是重要的死亡率预测因素。更好地了解这种不断变化的景观背后的原因对于改善PJP的管理和生存至关重要。
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