Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2021 Feb;96(2):400-407. doi: 10.1016/j.mayocp.2020.07.029.
To assess host factors in pneumocystis jirovecii pneumonia (PCP)-related hospitalizations and compare outcomes between HIV and non-HIV patients.
Using the National Inpatient Sample database, we identified 3384 hospitalizations with PCP (International Classification of Diseases, Ninth Revision, Clinical Modification code: 136.3) as the primary discharge diagnosis from 2005 to 2014. We evaluated hospitalizations for the following host factors: HIV, malignancies, organ transplantation, rheumatologic diseases, and vasculitides. We compared the prevalence of individual host factors among PCP hospitalizations over time, and compared intervention rates and outcomes between HIV and non-HIV patients with PCP.
Among all hospitalizations for PCP, malignancy was the most prevalent host factor (46.0%, n=1559), followed by HIV (17.8%, n=604); 60.7% (n=946) of malignancies were hematologic. The prevalence of HIV among hospitalizations for PCP decreased from 25.1% in 2005 to 9.2% in 2014 (P<.001), whereas the prevalence of non-HIV immunocompromising conditions increased. Compared with HIV patients, PCP patients without HIV had higher rates of bronchoscopy (52.3% vs 26.7%, P<.001) and endotracheal intubation (17.0% vs 7.9%, P<.001), prolonged hospitalizations (11.5 vs 8.7 days, P<.001), higher hospitalization costs (86.8 vs 48.2×10 USD, P<.001) and increased in-hospital mortality (16.0% vs 5.0%, P<.001). After adjusting for age, sex, and smoking status, there was no difference in mortality between non-HIV and HIV patients with PCP (adjusted odds ratio, 1.4; 95% CI, 0.9 to 2.3).
The epidemiology of PCP has shifted with an increase in the prevalence of non-HIV patients who have higher intubation rates and prolonged hospitalizations compared with matched HIV patients.
评估卡氏肺孢子菌肺炎（PCP）相关住院的宿主因素，并比较 HIV 患者和非 HIV 患者的结局。
我们使用国家住院患者样本数据库，从 2005 年至 2014 年确定了 3384 例以 PCP（国际疾病分类，第九版，临床修订版代码：136.3）为主要出院诊断的 PCP 住院病例。我们评估了以下宿主因素的住院情况：HIV、恶性肿瘤、器官移植、风湿性疾病和血管炎。我们比较了 PCP 住院患者中各种宿主因素的患病率随时间的变化，并比较了 HIV 患者和非 HIV 患者的干预率和结局。
在所有 PCP 住院患者中，恶性肿瘤是最常见的宿主因素（46.0%，n=1559），其次是 HIV（17.8%，n=604）；恶性肿瘤中 60.7%（n=946）为血液系统恶性肿瘤。2005 年 HIV 在 PCP 住院患者中的患病率为 25.1%，2014 年降至 9.2%（P<.001），而非 HIV 免疫抑制性疾病的患病率则有所增加。与 HIV 患者相比，非 HIV 患者的 PCP 患者支气管镜检查率（52.3% vs 26.7%，P<.001）和气管插管率（17.0% vs 7.9%，P<.001）更高，住院时间更长（11.5 天 vs 8.7 天，P<.001），住院费用更高（86.8 美元 vs 48.2×10 美元，P<.001），住院死亡率更高（16.0% vs 5.0%，P<.001）。调整年龄、性别和吸烟状况后，非 HIV 患者和 HIV 患者的死亡率无差异（调整后的优势比，1.4；95%CI，0.9 至 2.3）。
PCP 的流行病学发生了变化，非 HIV 患者的患病率增加，与匹配的 HIV 患者相比，这些患者的插管率更高，住院时间更长。
