Azoulay E, Parrot A, Flahault A, Cesari D, Lecomte I, Roux P, Saidi F, Fartoukh M, Bernaudin J F, Cadranel J, Mayaud C
Service de Pneumologie et Réanimation Respiratoire, Unité de Biostatistique, INSERM U444, France. Hôpital Tenon, Paris, France.
Am J Respir Crit Care Med. 1999 Aug;160(2):493-9. doi: 10.1164/ajrccm.160.2.9901019.
Factors predictive of mortality in patients with AIDS and Pneumocystis carinii pneumonia (PCP) were identified before the introduction of adjunctive steroids, but they have not been reevaluated since. Because PCP still occurs in AIDS, remaining fatal in some cases, we conducted a multivariate analysis of factors predicting mortality in patients with HIV-positive PCP managed from 1990 to 1995, i.e., after the consensus conference on the use of adjunctive steroids. The predictive value of clinical, laboratory, and bronchoalveolar lavage (BAL) data at admission and during the course of PCP was studied retrospectively using multivariate methods, in 144 patients with AIDS. Overall mortality was 21.5%. The univariate analysis identified seven factors predictive of 90-d mortality: Pa(O(2)) on room air < 60 mm Hg, lactate dehydrogenase > 1,000 IU, albuminemia < 30 g/L, BAL neutrophilia > 10%, nosocomial infection, pneumothorax, and a need for mechanical ventilation. Four of these factors were independently associated with 90-d mortality in the multivariate analysis; among them, two were evaluable at admission, namely, Pa(O(2)) < 60 mm Hg on room air and BAL neutrophilia > 10%, and two during hospitalization, namely, the development of pneumothorax and a need for mechanical ventilation. Moreover, BAL neutrophilia was correlated to occurrence of pneumothorax and a need for mechanical ventilation. In the era of adjunctive steroid use, AIDS-related PCP remains fairly common. Two independent factors evaluable at admission, Pa(O(2)) on room air and BAL neutrophilia, are predictive of death.
在辅助性类固醇药物应用之前，已确定了艾滋病合并卡氏肺孢子虫肺炎（PCP）患者的死亡预测因素，但此后未重新进行评估。由于PCP仍在艾滋病患者中出现，在某些情况下仍会致命，因此我们对1990年至1995年期间接受治疗的HIV阳性PCP患者的死亡预测因素进行了多变量分析，即辅助性类固醇药物使用共识会议之后。采用多变量方法对144例艾滋病患者入院时及PCP病程中的临床、实验室和支气管肺泡灌洗（BAL）数据的预测价值进行了回顾性研究。总体死亡率为21.5%。单变量分析确定了7个预测90天死亡率的因素：室内空气下的动脉血氧分压（Pa（O₂））<60 mmHg、乳酸脱氢酶>1000 IU、白蛋白血症<30 g/L、BAL中性粒细胞增多>10%、医院感染、气胸以及需要机械通气。在多变量分析中，其中4个因素与90天死亡率独立相关；其中，入院时可评估的2个因素为室内空气下的Pa（O₂）<60 mmHg和BAL中性粒细胞增多>10%，住院期间的2个因素为气胸的发生和需要机械通气。此外，BAL中性粒细胞增多与气胸的发生和需要机械通气相关。在辅助性类固醇药物使用时代，艾滋病相关的PCP仍然相当常见。入院时可评估的2个独立因素，即室内空气下的Pa（O₂）和BAL中性粒细胞增多，可预测死亡。
