小儿重症监护病房重症非hiv相关性肺囊虫肺炎的临床特征和结局

IF 2.3 3区医学 Q1 PEDIATRICS

Pediatric Pulmonology Pub Date : 2025-08-01 DOI:10.1002/ppul.71217

Kang An, Yali Han, Chengjuan Luo, Wenting Hu, Juan Qian

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引用次数: 0

摘要

背景：耶氏肺囊虫是免疫功能低下患者机会性肺炎的重要病因。本研究的目的是探讨免疫功能低下的非hiv儿童患者的杰氏肺囊虫肺炎（PJP）的临床、实验室、影像学特征和预后。方法：回顾性观察性研究。连续变量用中位数和四分位间距表示，采用Mann Whitney U检验。通过logistic回归模型评估与90天全因死亡率相关的危险因素。结果：22例患者（55%）曾接受过移植；肝移植19例（47.5%），异体造血干细胞移植3例（7.5%）。其余18例患者包括12例急性淋巴细胞白血病（30%）和6例其他（15%）。8例患者（20%）入院时出现休克。15例患者（37.5%）在PJP发病前接受过PJP预防。儿童重症监护病房（PICU）的中位住院时间为26（20-34）天，中位住院时间为18（11-25）天。30天全因死亡率为12.5%（5/40）。90天全因死亡率为22.5%（9/40）。与幸存者相比，非幸存者的儿童序事性器官衰竭评估评分（pSOFA）明显更高(11比4；结论：PJP在免疫功能低下的儿科患者中仍然危及生命。pSOFA是死亡率的重要危险因素。

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Clinical Characteristics and Outcomes of Severe Non-HIV Related Pneumocystis jirovecii Pneumonia in the Pediatric Intensive Care Unit.

Background: Pneumocystis jirovecii is an important cause of opportunistic pneumonia in immunocompromised patients. The aim of this study was to investigate the clinical, laboratory, imaging characteristics, and prognosis of Pneumocystis jirovecii pneumonia (PJP) in immunocompromised non-HIV pediatric patients.

Methods: This was a retrospective, observational study. Continuous variables were expressed as median and interquartile range and evaluated by Mann Whitney U test. Risk factors associated with 90-day all-cause mortality were evaluated by a logistic regression model.

Results: Twenty-two patients (55%) had previously undergone transplantation; 19 (47.5%) liver transplants and 3 (7.5%) allogeneic hematopoietic stem cell transplants. The remaining 18 patients included 12 with acute lymphoblastic leukemia (30%) with 6 others (15%). Eight patients (20%) presented with shock on admission. Fifteen patients (37.5%) had received PJP prophylaxis before PJP onset. The median duration of hospitalization was 26 (20-34) days with a median saty of 18 (11-25) days in the pediatric intensive care unit (PICU). The 30 day all-cause mortality was 12.5% (5/40). The 90 day all-cause mortality was 22.5% (9/40). Compared with survivors, non-survivors had a significantly higher Pediatric Sequential Organ Failure Assessment Score (pSOFA) (11 vs 4; p < 0.01) and lower SpO2 at presentation (88% vs 90%; p = 0.046). Multivariate analysis showed that the pSOFA [95% CI 1.983 (1.183-3.325); p = 0.009)] was the only significant risk factor for mortality. Although there was no statistically significant difference, patients who received adjunctive glucocorticoid therapy had a shorter duration of mechanical ventilation compared to those who did not (12 vs. 15 days; p = 0.26).

Conclusions: PJP remains life-threatening in immunocompromised pediatric patients. pSOFA was a significant risk factor for mortality.

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来源期刊

Pediatric Pulmonology 医学-呼吸系统

CiteScore

6.00

自引率

12.90%

发文量

468

审稿时长

3-8 weeks

期刊介绍： Pediatric Pulmonology (PPUL) is the foremost global journal studying the respiratory system in disease and in health as it develops from intrauterine life though adolescence to adulthood. Combining explicit and informative analysis of clinical as well as basic scientific research, PPUL provides a look at the many facets of respiratory system disorders in infants and children, ranging from pathological anatomy, developmental issues, and pathophysiology to infectious disease, asthma, cystic fibrosis, and airborne toxins. Focused attention is given to the reporting of diagnostic and therapeutic methods for neonates, preschool children, and adolescents, the enduring effects of childhood respiratory diseases, and newly described infectious diseases. PPUL concentrates on subject matters of crucial interest to specialists preparing for the Pediatric Subspecialty Examinations in the United States and other countries. With its attentive coverage and extensive clinical data, this journal is a principle source for pediatricians in practice and in training and a must have for all pediatric pulmonologists.