Zhong Yuxia, Ji Ting, Qin Dan, Cheng Deyun
Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, China.
Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, China.
J Mycol Med. 2023 Mar;33(1):101330. doi: 10.1016/j.mycmed.2022.101330. Epub 2022 Sep 8.
To analyze clinical characteristics and risk factors for in-hospital mortality in patients coinfected with P. jirovecii and Aspergillus.
This study included 53 patients with coinfection of P. jirovecii pneumonia (PJP) and invasive pulmonary aspergillosis (IPA) in our center from January 2011 to December 2021. All cases were divided into survivor (n=27) and non-survivor groups (n=26). Medical records, laboratory and radiology data were collected. Risk factors for in-hospital mortality were identified by multivariable analyses.
HIV-positive patients accounted for 3.8%. Fever (77.4%), dyspnea (69.8%) and wet cough (24.5%) were common symptoms. Ground-glass opacity (83.0%), consolidation (71.7%), septal thickening (66.0%), and nodules (54.7%) were the most common radiological signs. CD4+ T cell count and serum albumin (ALB) level were significantly lower in non-survival group than in the survival group. Conversely, serum lactate dehydrogenase (LDH) and procalcitonin (PCT) levels were higher in non-survival group than in survival group. Lactic acidosis [odds ratio (OR): 33.999,95% confidential interval (CI): 3.112-371.409; p=0.004], low CD4+ T cell count (<114 cell/µL) [OR: 19.343, 95% CI: 1.533-259.380; p=0.022] and high level of LDH (> 519 U/L) [OR: 11.422, 95% CI: 1.271-102.669; p=0.030] were independent risk factors for mortality.
PJP coinfected with IPA incurs high mortality with nonspecific clinical characteristics and is more likely to involve HIV-negative patients. Lactic acidosis, low CD4+ T cell count and high LDH level are independent risk factors for mortality, close monitoring of these parameters is necessary to help distinguish high-risk patients and make appropriate clinical decisions.
分析耶氏肺孢子菌和曲霉合并感染患者的临床特征及院内死亡的危险因素。
本研究纳入了2011年1月至2021年12月在本中心的53例耶氏肺孢子菌肺炎（PJP）和侵袭性肺曲霉病（IPA）合并感染患者。所有病例分为存活组（n = 27）和非存活组（n = 26）。收集病历、实验室和影像学数据。通过多变量分析确定院内死亡的危险因素。
HIV阳性患者占3.8%。发热（77.4%）、呼吸困难（69.8%）和湿性咳嗽（24.5%）是常见症状。磨玻璃影（83.0%）、实变（71.7%）、小叶间隔增厚（66.0%）和结节（54.7%）是最常见的影像学表现。非存活组的CD4 + T细胞计数和血清白蛋白（ALB）水平显著低于存活组。相反，非存活组的血清乳酸脱氢酶（LDH）和降钙素原（PCT）水平高于存活组。乳酸酸中毒[比值比（OR）：33.999，95%置信区间（CI）：3.112 - 371.409；p = 0.004]、低CD4 + T细胞计数（<114个细胞/μL）[OR：19.343，95% CI：1.533 - 259.380；p = 0.022]和高水平的LDH（>519 U/L）[OR：11.422，95% CI：1.271 - 102.669；p = 0.030]是死亡的独立危险因素。
PJP合并IPA死亡率高，临床特征不特异，且更易累及HIV阴性患者。乳酸酸中毒、低CD4 + T细胞计数和高LDH水平是死亡的独立危险因素，密切监测这些参数有助于区分高危患者并做出适当的临床决策。
