Peschel Georg, Happ Nils, Bornschein Jan, Weis Florian, Schmid Stephan, Mueller Martina, Selgrad Michael
Department of Internal Medicine I, University Hospital of Regensburg, Regensburg, Germany.
Department of Gastroenterology and Oncology, Hospital of Fürstenfeldbruck, Fürstenfeldbruck, Germany.
Front Med (Lausanne). 2024 Oct 9;11:1474835. doi: 10.3389/fmed.2024.1474835. eCollection 2024.
Pneumocystis jirovecci pneumonia (PCP) is a life threating disease in immunodeficient patients. Liver cirrhosis itself can lead to immunodefiency, however little is known if Pneumocystis jirovecci infection affects the outcome of patients with liver cirrhosis.
We aimed to assess the predictors for Pneumocystis jirovecci-associated mortality in patients with Pneumocystis jirovecci infection treated at intensive care units.
A total of 151 patients hospitalized between January 2013 and November 2019 with a PCR-confirmed Pneumocystis jirovecci infection were retrospectively included in this study and analysed for clinical predictors for PCJ associated mortality.
The overall mortality in our patient cohort was 60%. Out of 151 patients included in the analysis, 67 (44%) patients suffered from liver cirrhosis. Patients with an advanced liver cirrhosis (Child-Pugh class C) showed the highest mortality rate of 84.7%. The presence of a liver cirrhosis was associated with a significant increased risk of mortality (OR: 4.809) ([95%-CI: 2.32-9.97]; < 0.001). There was a significant correlation of Meld score and mortality ( = 0.612, < 0.001).
To our knowledge, this study represents the largest evaluation of Pneumocystis jirovecci infection in patients with advanced liver cirrhosis. Cirrhosis associated immune dysfunction (CAID) describes the spectrum of immunological disturbances in patients with cirrhosis, which is linked to a heightened vulnerability to bacterial infections. Our data indicate a heightened susceptibility to fungal infections. Understanding the phenotypic manifestations of CAID could lead to immune-targeted therapies aimed at reducing infection susceptibility and decreasing CAID-associated mortality in cirrhosis patients.
耶氏肺孢子菌肺炎（PCP）是免疫缺陷患者的一种危及生命的疾病。肝硬化本身可导致免疫缺陷，然而，关于耶氏肺孢子菌感染是否会影响肝硬化患者的预后知之甚少。
我们旨在评估在重症监护病房接受治疗的耶氏肺孢子菌感染患者中，耶氏肺孢子菌相关死亡率的预测因素。
本研究回顾性纳入了2013年1月至2019年11月期间住院的151例经PCR确诊为耶氏肺孢子菌感染的患者，并分析了PCJ相关死亡率的临床预测因素。
我们患者队列的总体死亡率为60%。在纳入分析的151例患者中，67例（44%）患有肝硬化。晚期肝硬化（Child-Pugh C级）患者的死亡率最高，为84.7%。肝硬化的存在与死亡率显著增加相关（OR：4.809）（[95%置信区间：2.32-9.97]；P<0.001）。Meld评分与死亡率存在显著相关性（r=0.612，P<0.001）。
据我们所知，本研究是对晚期肝硬化患者耶氏肺孢子菌感染的最大规模评估。肝硬化相关免疫功能障碍（CAID）描述了肝硬化患者的免疫紊乱谱，这与细菌感染易感性增加有关。我们的数据表明对真菌感染的易感性增加。了解CAID的表型表现可能会导致针对免疫的治疗方法，旨在降低感染易感性并降低肝硬化患者CAID相关的死亡率。
