Liu Chia-Jung, Lee Tai-Fen, Ruan Sheng-Yuan, Yu Chong-Jen, Chien Jung-Yien, Hsueh Po-Ren
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Infect Drug Resist. 2019 May 30;12:1457-1467. doi: 10.2147/IDR.S199761. eCollection 2019.
The incidence of pneumonia (PCP) has been increasing among non-HIV-infected patients. Here, we investigated the clinical characteristics, treatment outcomes, and prognostic factors of PCP in non-HIV-infected patients. Information on clinical characteristics, treatment outcomes, and prognostic factors of PCP patients who were treated at a medical center in northern Taiwan from October 2015 to October 2016 were retrieved from medical records and evaluated. Among the patients with PCP included in the study, 84 were non-HIV-infected and 25 were HIV-infected. Non-HIV-infected patients with PCP had a longer duration between radiographic findings and treatment (<0.001), and a higher rate of hospital-associated PCP (<0.001), hypoxia (0.015), respiratory failure (<0.001), and mortality (0.006) than HIV-infected patients with PCP. Among non-HIV-infected patients, non-survivors had a higher fungal burden (46.2% vs 22.2%, =0.039), higher requirement for adjunctive steroid treatment (94.9% vs 71.1%, 0.011), and higher rate of pneumothorax (17.9% vs 2.2%, 0.038) than survivors. Multiple logistic regression revealed that lymphopenia (odds ratio [OR] =3.24, 95% confidence interval [CI] =1.07-9.79; 0.037), adjunctive steroid use (OR =6.23, 95% CI =1.17-33.14; 0.032), and pneumothorax (OR =10.68, 95% CI =1.00-113.93; 0.050) were significantly associated with increased 60-day mortality among non-HIV-infected PCP patients. Lymphopenia, adjunctive steroid therapy, and pneumothorax were significantly associated with higher mortality in non-HIV-infected patients with PCP.
在非HIV感染患者中，肺炎（肺孢子菌肺炎，PCP）的发病率一直在上升。在此，我们调查了非HIV感染患者中PCP的临床特征、治疗结果及预后因素。从病历中检索并评估了2015年10月至2016年10月在台湾北部一家医疗中心接受治疗的PCP患者的临床特征、治疗结果及预后因素信息。纳入该研究的PCP患者中，84例为非HIV感染，25例为HIV感染。与HIV感染的PCP患者相比，非HIV感染的PCP患者影像学表现与治疗之间的间隔时间更长（<0.001），医院获得性PCP的发生率更高（<0.001）、缺氧发生率更高（0.015）、呼吸衰竭发生率更高（<0.001）以及死亡率更高（0.006）。在非HIV感染患者中，非幸存者的真菌负荷更高（46.2% 对22.2%，P =0.039）、辅助性类固醇治疗的需求更高（94.9% 对71.1%，P =0.011）以及气胸发生率更高（17.9% 对2.2%，P =0.038）。多因素逻辑回归分析显示，淋巴细胞减少（比值比[OR]=3.24，95%置信区间[CI]=1.07 - 9.79；P =0.037）、辅助性类固醇的使用（OR =6.23，95% CI =1.17 - 33.14；P =0.032）和气胸（OR =10.68，95% CI =1.00 - 113.93；P =0.050）与非HIV感染的PCP患者60天死亡率增加显著相关。淋巴细胞减少、辅助性类固醇治疗和气胸与非HIV感染的PCP患者更高的死亡率显著相关。
