China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China.
Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
Clin Respir J. 2022 Feb;16(2):152-161. doi: 10.1111/crj.13463. Epub 2022 Jan 10.
BACKGROUND: The incidence of Pneumocystis pneumonia (PCP) among patients without human immunodeficiency virus (HIV) infection continues to increase. Here, we identified potential risk factors for in-hospital mortality among HIV-negative patients with PCP admitted to the intensive care unit (ICU). METHODS: We retrospectively analyzed medical records of 154 non-HIV-infected PCP patients admitted to the ICU at Peking Union Medical College Hospital (PUMCH) and China-Japan Friendship Hospital (CJFH) from October 2012 to July 2020. Clinical characteristics were examined, and factors related to in-hospital mortality were analyzed. RESULTS: A total of 154 patients were enrolled in our study. Overall, the in-hospital mortality rate was 65.6%. The univariate analysis indicated that nonsurvivors were older (58 vs. 52 years, P = 0.021), were more likely to use high-dose steroids (≥1 mg/kg/day prednisone equivalent, 39.62% vs. 55.34%, P = 0.047), receive caspofungin during hospitalization (44.6% vs. 28.3%, P = 0.049), require invasive ventilation (83.2% vs. 47.2%, P < 0.001), develop shock during hospitalization (61.4% vs. 20.8%, P < 0.001), and develop pneumomediastinum (21.8% vs. 47.2%, P = 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores on ICU admission (20.32 vs. 17.39, P = 0.003), lower lymphocyte counts (430 vs. 570 cells/μl, P = 0.014), and lower PaO2/FiO2 values (mmHg) on admission (108 vs. 147, P = 0.001). Multivariate analysis showed that age (odds ratio [OR] 1.03; 95% confidence interval [CI] 1.00-1.06; P = 0.024), use of high-dose steroids (≥1 mg/kg/day prednisone equivalent) during hospitalization (OR 2.29; 95% CI 1.07-4.90; P = 0.034), and a low oxygenation index on admission (OR 0.99; 95% CI 0.99-1.00; P = 0.014) were associated with in-hospital mortality. CONCLUSIONS: The mortality rate of non-HIV-infected patients with PCP was high, and predictive factors of a poor prognosis were advanced age, use of high-dose steroids (≥1 mg/kg/day prednisone equivalent) during hospitalization, and a low oxygenation index on admission. The use of caspofungin during hospitalization might have no contribution to the prognosis of non-HIV-infected patients with PCP in the ICU.
背景：非人类免疫缺陷病毒（HIV）感染患者中肺囊虫肺炎（PCP）的发病率持续上升。在这里，我们确定了入住重症监护病房（ICU）的非 HIV 感染 PCP 患者院内死亡的潜在危险因素。
方法：我们回顾性分析了 2012 年 10 月至 2020 年 7 月期间北京协和医院（PUMCH）和中日友好医院（CJFH）收治的 154 例非 HIV 感染 PCP 患者的病历。检查了临床特征，并分析了与院内死亡相关的因素。
结果：共纳入 154 例患者。总体而言，院内死亡率为 65.6%。单因素分析表明，非幸存者年龄更大（58 岁比 52 岁，P=0.021），更有可能使用大剂量类固醇（≥1mg/kg/天泼尼松等效剂量，39.62%比 55.34%，P=0.047），住院期间使用卡泊芬净（44.6%比 28.3%，P=0.049），需要有创通气（83.2%比 47.2%，P<0.001），住院期间发生休克（61.4%比 20.8%，P<0.001），发生纵隔气肿（21.8%比 47.2%，P=0.001），入住 ICU 时急性生理学和慢性健康评估（APACHE）Ⅱ评分更高（20.32 比 17.39，P=0.003），淋巴细胞计数更低（430 比 570 细胞/μl，P=0.014），入院时氧合指数更低（108 比 147，P=0.001）。多因素分析表明，年龄（比值比[OR]1.03；95%置信区间[CI]1.00-1.06；P=0.024）、住院期间使用大剂量类固醇（≥1mg/kg/天泼尼松等效剂量）（OR 2.29；95%CI 1.07-4.90；P=0.034）和入院时低氧合指数（OR 0.99；95%CI 0.99-1.00；P=0.014）与院内死亡相关。
结论：非 HIV 感染 PCP 患者的死亡率较高，预后不良的预测因素为高龄、住院期间使用大剂量类固醇（≥1mg/kg/天泼尼松等效剂量）和入院时低氧合指数。住院期间使用卡泊芬净可能对非 HIV 感染 PCP 患者在 ICU 的预后没有贡献。
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