Festic Emir, Gajic Ognjen, Limper Andrew H, Aksamit Timothy R
Division of Primary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Chest. 2005 Aug;128(2):573-9. doi: 10.1378/chest.128.2.573.
To examine outcome and associated factors of acute respiratory failure (ARF) in non-HIV-related Pneumocystis pneumonia (PCP) in patients admitted to a medical ICU between 1995 and 2002.
A retrospective review of medical records and an APACHE (acute physiology and chronic health evaluation) III database.
Academic tertiary medical center.
We identified 30 patients with non-HIV-related PCP and ARF. In-hospital, 6-month, and 1-year mortality rates were 67%, 77%, and 80%, respectively. Median age was 63.5 years. Median APACHE III score on day 1 was 65.5. Median ICU and hospital lengths of stay were 13 days and 21 days, respectively. All seven patients having a pneumothorax died. All but one patient had an elevated lactate dehydrogenase level (median, 563 U/L). The diagnosis was made using BAL in 28 patients and by transbronchial biopsy in the remaining 2 patients. All patients were immunosuppressed (eight were receiving corticosteroids, seven were receiving chemotherapy, and the remainder received both). Median immunosuppressive prednisone-equivalent dose was 40 mg (median length of treatment, 4.5 months). Not a single patient received PCP prophylaxis. All but one patient required intubation and invasive positive pressure ventilation (PPV). Hospital mortality was associated with high APACHE III scores on day 1 (p = 0.05), intubation delay (p = 0.03), length of PPV (p = 0.003), and development of pneumothorax (p = 0.033). Logistic regression analysis demonstrated that association of intubation delay with hospital mortality persisted after adjusting for severity of illness (p = 0.03).
Among patients with ARF secondary to non-HIV-related PCP, poor prognostic factors include high APACHE III scores, intubation delay, longer duration of PPV, and development of pneumothorax. None of the patients in this series received PCP prophylaxis prior to the development of pneumonia.
研究1995年至2002年期间入住内科重症监护病房（ICU）的非HIV相关肺孢子菌肺炎（PCP）患者急性呼吸衰竭（ARF）的结局及相关因素。
对病历和急性生理与慢性健康状况评估（APACHE）III数据库进行回顾性分析。
学术性三级医疗中心。
我们确定了30例非HIV相关PCP合并ARF患者。住院死亡率、6个月死亡率和1年死亡率分别为67%、77%和80%。中位年龄为63.5岁。第1天的APACHE III评分中位数为65.5。ICU住院时间和住院时间中位数分别为13天和21天。所有7例气胸患者均死亡。除1例患者外，所有患者乳酸脱氢酶水平均升高（中位数为563 U/L）。28例患者通过支气管肺泡灌洗（BAL）确诊，其余2例通过经支气管活检确诊。所有患者均有免疫抑制（8例接受皮质类固醇治疗，7例接受化疗，其余患者两者均接受）。免疫抑制泼尼松等效剂量中位数为40 mg（治疗时间中位数为4.5个月）。无一例患者接受PCP预防。除1例患者外，所有患者均需要插管和有创正压通气（PPV）。住院死亡率与第1天的高APACHE III评分（p = 0.05）、插管延迟（p = 0.03）、PPV时间（p = 0.003）和气胸发生（p = 0.033）相关。逻辑回归分析表明，在调整疾病严重程度后，插管延迟与住院死亡率的相关性仍然存在（p = 0.03）。
在非HIV相关PCP继发ARF患者中，预后不良因素包括高APACHE III评分、插管延迟、PPV持续时间延长和气胸发生。本系列中无一例患者在肺炎发生前接受PCP预防。
