Hamada Shohei, Ichiyasu Hidenori, Inaba Megumi, Takahashi Hiroshi, Sadamatsu Tomoki, Akaike Kimitaka, Masunaga Aiko, Tashiro Yasumasa, Hirata Naomi, Yoshinaga Takeshi, Sakagami Takuro
Dept of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Division of Respiratory Medicine, Kumamoto Chuo Hospital, Kumamoto, Japan.
ERJ Open Res. 2020 May 4;6(2). doi: 10.1183/23120541.00306-2019. eCollection 2020 Apr.
The increasing incidence of life-threatening pneumonia (PCP) in non-HIV immunocompromised patients is a global concern. Yet, no reports have examined the prognostic significance of pre-existing interstitial lung disease (ILD) in non-HIV PCP.
We retrospectively reviewed the medical records of non-HIV PCP patients with (ILD group) or without (non-ILD group) pre-existing ILD. The clinical features and outcomes of the ILD group were compared with those of the non-ILD group. Cox regression models were constructed to identify prognostic factors.
74 patients were enrolled in this study. The 90-day mortality was significantly higher in the ILD group than in the non-ILD group (62.5% 19.0%, p<0.001). In the ILD group, patients with a higher percentage of bronchoalveolar lavage fluid neutrophils had worse outcomes compared to those having a lower percentage (p=0.026). Multivariate analyses revealed that pre-existing ILD (p=0.002) and low levels of serum albumin (p=0.009) were independent risk factors for 90-day mortality. Serum levels of β-d-glucan were significantly reduced after treatment of PCP in both groups, whereas levels of Krebs von den Lungen-6 (KL-6) significantly increased in the ILD group. In the ILD group, the 90-day mortality of patients with increasing KL-6 levels after treatment was significantly higher than those with decreasing levels (78.9% 0%, p=0.019).
In non-HIV PCP patients, pre-existing ILD is associated with a poorer prognosis. Prophylaxis for PCP is needed in patients with pre-existing ILD under immunosuppression.
非HIV免疫功能低下患者中危及生命的肺炎（肺孢子菌肺炎，PCP）发病率不断上升，这是一个全球关注的问题。然而，尚无报告探讨非HIV PCP患者中既往存在的间质性肺疾病（ILD）的预后意义。
我们回顾性分析了有（ILD组）或无（非ILD组）既往ILD的非HIV PCP患者的病历。将ILD组的临床特征和结局与非ILD组进行比较。构建Cox回归模型以确定预后因素。
本研究共纳入74例患者。ILD组的90天死亡率显著高于非ILD组（62.5%对19.0%，p<0.001）。在ILD组中，支气管肺泡灌洗液中性粒细胞百分比更高的患者与百分比更低的患者相比，结局更差（p=0.026）。多因素分析显示，既往ILD（p=0.002）和血清白蛋白水平低（p=0.009）是90天死亡率的独立危险因素。两组PCP治疗后血清β-d-葡聚糖水平均显著降低，而ILD组中Krebs von den Lungen-6（KL-6）水平显著升高。在ILD组中，治疗后KL-6水平升高的患者90天死亡率显著高于水平降低的患者（78.9%对0%，p=0.019）。
在非HIV PCP患者中，既往存在的ILD与较差的预后相关。免疫抑制状态下有既往ILD的患者需要预防PCP。
