Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Department of Geriatrics, Peking University First Hospital, Beijing, China.
Front Cell Infect Microbiol. 2024 Jul 10;14:1380494. doi: 10.3389/fcimb.2024.1380494. eCollection 2024.
Compared with (HIV) patients, non-HIV patients with pneumonia (PCP) have more rapid onset, more rapid progression, and higher mortality.
To investigate the predictive value of variables obtained upon hospital admission for in-hospital death and 90-day outcomes in non-HIV-PCP patients with respiratory failure (RF).
This was a single center retrospective study in a tertiary care institution over 15 years. It included all adults inpatients (≥18 years old) with laboratory confirmed non-HIV-PCP with RF who were discharged or died from Peking University First Hospital between April 1st, 2007 and November 1st, 2022. Epidemiological, clinical, laboratory, imaging and outcome data were collected from patient records.
In this study, a total of 146 non-HIV-PCP patients with RF were included. There were 57 patients (39%) died during hospitalization, 44 patients (53%) died in Intensive care unit (ICU). A total of 137 patients completed 90 days of follow-up, of which 58 (42.3%) died. The multivariable regression analysis revealed that a CD8 T cell count <115/μl (=0.009), bronchoalveolar lavage fluid (BALF)-neutrophil percentage ≥50% (=0.047), the time from corticosteroids withdrawal to symptom onset ≤5 days (=0.012), and the time from visit to initiation of sulfonamides ≥2 days (=0.011) were independent risk factors for in-hospital death. Furthermore, a CD8 T cell count < 115/μl (=0.001) and the time from visit to initiation of sulfonamides therapy ≥2 days (=0.033) was independently associated with 90-day all-cause death.
A low CD8 T cell count in peripheral blood, a high percentage of BALF-neutrophils, a short time from corticosteroids withdrawal to symptom onset, and a long time from visit to initiation of sulfonamides are associated with poor prognosis in non-HIV-PCP patients with RF.
与艾滋病病毒（HIV）感染者相比，患有肺炎（PCP）的非 HIV 患者发病更急、进展更快、死亡率更高。
探讨获得性免疫缺陷综合征（AIDS）以外的患肺炎（PCP）合并呼吸衰竭（RF）患者入院时的变量对住院死亡和 90 天结局的预测价值。
这是一项在 15 年内在一家三级医疗机构进行的单中心回顾性研究。纳入 2007 年 4 月 1 日至 2022 年 11 月 1 日期间从北京大学第一医院出院或因 PCP 合并 RF 死亡的所有成人住院患者（年龄≥18 岁）。从病历中收集流行病学、临床、实验室、影像学和结局数据。
本研究共纳入 146 例 RF 合并非 HIV-PCP 患者。住院期间死亡 57 例（39%），重症监护病房（ICU）死亡 44 例（53%）。137 例患者完成了 90 天随访，其中 58 例（42.3%）死亡。多变量回归分析显示，CD8 T 细胞计数<115/μl（=0.009）、支气管肺泡灌洗液（BALF）中性粒细胞百分比≥50%（=0.047）、皮质类固醇停药至症状出现时间≤5 天（=0.012）以及就诊至开始使用磺胺类药物时间≥2 天（=0.011）是住院死亡的独立危险因素。此外，CD8 T 细胞计数<115/μl（=0.001）和就诊至开始磺胺类药物治疗时间≥2 天（=0.033）与 90 天全因死亡独立相关。
外周血 CD8 T 细胞计数低、BALF 中性粒细胞百分比高、皮质类固醇停药至症状出现时间短、就诊至开始使用磺胺类药物时间长与非 HIV-PCP 合并 RF 患者预后不良相关。
