风湿性疾病合并肺孢子菌肺炎患者的临床特征和预后预测因素。
Clinical features and prognostic predictors in patients with rheumatic diseases complicated by Pneumocystis pneumonia.
机构信息
Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei City, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan.
出版信息
Int J Infect Dis. 2022 Sep;122:1018-1025. doi: 10.1016/j.ijid.2022.07.070. Epub 2022 Jul 30.
OBJECTIVES
To investigate the clinical outcomes and risk factors of mortality in patients with rheumatic diseases complicated by Pneumocystis pneumonia (PCP).
METHODS
Between November 2015 and April 2021, patients with rheumatic diseases with PCP in a tertiary referral hospital were retrospectively enrolled. The diagnosis of PCP requires the fulfillment of clinical, radiographic, and microbiological criteria. Factors associated with in-hospital, 30-day, and 90-day mortality were evaluated.
RESULTS
A total of 128 patients with rheumatic diseases who had a positive quantitative polymerase chain reaction assay for Pneumocystis jirovecii were screened, and 72 patients were included in the final analysis. The median (interquartile range [IQR]) pneumonia severity index (PSI) was 101.5 (77.0-132.0). The median (IQR) adjunctive corticosteroid dosage was 0.6 (0.4-0.9) mg/kg/day prednisolone equivalent. The receiver operating characteristic curve analysis showed that the optimal cutoff point of median adjunctive corticosteroid dosage was 0.6 mg/kg/day to predict in-hospital, 30-day, and 90-day mortality. In the multivariable logistic regression analysis, median adjunctive corticosteroid dosage ≥0.6 mg/kg/day and PSI >90 were independent factors of in-hospital, 30-day, and 90-day mortality.
CONCLUSION
A median adjunctive corticosteroid dosage of ≥0.6 mg/kg/day might be associated with mortality in patients with rheumatic diseases complicated by PCP.
目的
研究风湿性疾病合并卡氏肺孢子虫肺炎（PCP）患者的临床转归和死亡风险因素。
方法
回顾性纳入 2015 年 11 月至 2021 年 4 月期间在一家三级转诊医院就诊的风湿性疾病合并 PCP 的患者。PCP 的诊断需要满足临床、影像学和微生物学标准。评估了与住院期间、30 天和 90 天死亡率相关的因素。
结果
共筛选了 128 例经定量聚合酶链反应检测为卡氏肺孢子虫阳性的风湿性疾病患者，最终有 72 例患者纳入了最终分析。肺炎严重指数（PSI）中位数（四分位距[IQR]）为 101.5（77.0-132.0）。辅助性皮质类固醇剂量中位数（IQR）为 0.6（0.4-0.9）mg/kg/ 天泼尼松等效剂量。受试者工作特征曲线分析显示，辅助性皮质类固醇剂量中位数为 0.6mg/kg/天是预测住院期间、30 天和 90 天死亡率的最佳截断值。在多变量逻辑回归分析中，辅助性皮质类固醇剂量中位数≥0.6mg/kg/天和 PSI>90 是住院期间、30 天和 90 天死亡率的独立因素。
结论
辅助性皮质类固醇剂量中位数≥0.6mg/kg/天可能与风湿性疾病合并 PCP 患者的死亡率相关。
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