Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
School of Medicine, Tsinghua University, Beijing, 100091, China.
Eur J Clin Microbiol Infect Dis. 2021 Nov;40(11):2305-2314. doi: 10.1007/s10096-021-04227-0. Epub 2021 May 28.
Pneumocystis jirovecii pneumonia (PCP) is a life-threatening opportunistic infection in idiopathic membranous nephropathy (IMN) patients, who are treated with immunosuppressive drugs. However, the risk factors of infection and their prognosis are rarely investigated. We aimed to characterize the clinical manifestations of PCP in patients with IMN, and to understand their risk factors, so that we can provide early warnings to patients with high risk and potential poor prognosis. We conducted a retrospective observational study of IMN patients in a referral center in China, from Jan 2012 to Dec 2018. Clinical and laboratory data were collected separately at the time of IMN and PCP diagnosis. Patients with PCP were matched to those without by gender and age at a ratio of 1:4. The risk factors and prognostic factors were determined by univariate and multivariate logistic regression analysis. A total of 879 patients with IMN were included, with a median follow-up of 267 (interquartile range (IQR) 64,842) days. In total, 26 (2.96%) of them were diagnosed with PCP. The infection rate increased to 3.87% among patients who received corticosteroids, and it further increased to 5.49% in those received over 0.5mg/kg prednisone. Univariate analysis indicated that initial usage of corticosteroids, use of cyclophosphamide, reduced estimated glomerular filtration rate (eGFR), and higher 24-h proteinuria were related to the PCP susceptibility. Multivariate analysis revealed that corticosteroid treatment and reduced eGFR increased the risk of the Pneumocystis jirovecii infection. The case fatality rate of the PCP patients was 23.08%, and increased to 75% among patients requiring invasive ventilation. Univariate analysis indicated that pulmonary insufficiency, invasive ventilation, decreased eGFR, and increased lactate dehydrogenase at presentation were linked to poor prognosis. PCP is not rare in patients with IMN, especially those on corticosteroids, and presented with decreased eGFR. Considering the high case fatality rate, further studies are in need for prevention and management of these patients.
卡氏肺孢子虫肺炎（PCP）是特发性膜性肾病（IMN）患者在接受免疫抑制剂治疗时发生的危及生命的机会性感染。然而，感染的危险因素及其预后很少被研究。我们旨在描述 IMN 患者 PCP 的临床表现，并了解其危险因素，以便为高危和潜在预后不良的患者提供预警。我们对 2012 年 1 月至 2018 年 12 月期间在中国某转诊中心的 IMN 患者进行了回顾性观察性研究。分别在 IMN 和 PCP 诊断时收集临床和实验室数据。PCP 患者按性别和年龄与 IMN 患者以 1:4 的比例配对。通过单变量和多变量逻辑回归分析确定危险因素和预后因素。共纳入 879 例 IMN 患者，中位随访时间为 267（四分位距（IQR）：64，842）天。其中，26 例（2.96%）诊断为 PCP。接受皮质类固醇治疗的患者感染率增加到 3.87%，而接受泼尼松 0.5mg/kg 以上治疗的患者感染率进一步增加到 5.49%。单变量分析表明，初始使用皮质类固醇、使用环磷酰胺、估算肾小球滤过率（eGFR）降低和 24 小时蛋白尿增加与 PCP 易感性相关。多变量分析显示，皮质类固醇治疗和 eGFR 降低增加了卡氏肺孢子虫感染的风险。PCP 患者的病死率为 23.08%，需要有创通气的患者病死率增加到 75%。单变量分析表明，肺功能不全、有创通气、eGFR 降低和就诊时乳酸脱氢酶升高与预后不良有关。PCP 在 IMN 患者中并不罕见，尤其是在接受皮质类固醇治疗且 eGFR 降低的患者中。鉴于病死率高，需要进一步研究这些患者的预防和管理。
