Wills Nicola K, Tavares Jared, Said-Hartley Qonita, Wasserman Sean
Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Statistics, Faculty of Science, University of Cape Town, Cape Town, South Africa.
South Afr J HIV Med. 2024 Nov 8;25(1):1636. doi: 10.4102/sajhivmed.v25i1.1636. eCollection 2024.
Definition of chest X-ray (CXR) features associated with laboratory-confirmed pneumocystis pneumonia (PCP) among HIV-positive adults is needed to improve diagnosis in high-burden settings.
Our primary objective was to identify CXR features associated with confirmed PCP diagnosis and severe PCP (defined by hypoxia, intensive care unit referral/admission, and/or in-hospital death). We also explored the performance of logistic regression models, incorporating selected clinical and CXR predictors, for PCP diagnosis and severe PCP.
We conducted a case-control study involving HIV-positive adults with laboratory-confirmed PCP and a matched cohort with non-PCP respiratory presentations at regional hospitals in Cape Town, South Africa (2012-2020).
Records from 104 adults (52 PCP cases and 52 non-PCP controls) were included. Diffuse versus patchy ground-glass opacification was associated with increased odds of PCP diagnosis (adjusted odds ratio [aOR]: 6.2, 95% confidence interval [CI]: 1.6-28.9, = 0.01) and severe PCP (aOR: 4.5, 95% CI: 1.6-14.4, = 0.008). Consolidation was associated with severe PCP (aOR: 3.3, 95% CI: 1.2-11.0, = 0.03) as was increasing ground-glass zone involvement (aOR: 2.1 for each one-unit increase in involved zone; 95% CI: 1.4-3.2, = 0.0004). Models incorporating hypoxia (hypoxia model) or tachypnoea (respiratory rate model) with diffuse ground-glass opacities, absence of pleural effusion or reticular/reticulonodular changes on CXR performed well in predicting PCP (area under the receiver operating characteristic curve 0.828 [hypoxia model] and 0.857 [respiratory rate model]).
CXR evaluation alongside bedside clinical information offers good accuracy for discriminating definite PCP from other HIV-associated respiratory diseases.
在高负担环境中，需要明确与实验室确诊的肺孢子菌肺炎（PCP）相关的胸部X线（CXR）特征，以改善诊断。
我们的主要目标是确定与确诊的PCP诊断及严重PCP（定义为低氧血症、转入重症监护病房/住院或院内死亡）相关的CXR特征。我们还探讨了纳入选定临床和CXR预测因素的逻辑回归模型对PCP诊断及严重PCP的预测效能。
我们在南非开普敦的地区医院开展了一项病例对照研究，纳入实验室确诊PCP的HIV阳性成人以及有非PCP呼吸道表现的匹配队列（2012 - 2020年）。
纳入了104名成人的记录（52例PCP病例和52例非PCP对照）。弥漫性与斑片状磨玻璃样混浊与PCP诊断几率增加相关（调整优势比[aOR]：6.2，95%置信区间[CI]：1.6 - 28.9，P = 0.01）以及严重PCP（aOR：4.5，95% CI：1.6 - 14.4，P = 0.008）。实变与严重PCP相关（aOR：3.3，95% CI：1.2 - 11.0，P = 0.03），磨玻璃样区域累及增加也与之相关（累及区域每增加一个单位，aOR为2.1；95% CI：1.4 - 3.2，P = 0.0004）。纳入低氧血症（低氧血症模型）或呼吸急促（呼吸频率模型）以及CXR上弥漫性磨玻璃样混浊且无胸腔积液或网状/网状结节状改变的模型在预测PCP方面表现良好（受试者工作特征曲线下面积为0.828[低氧血症模型]和0.857[呼吸频率模型]）。
结合床边临床信息进行CXR评估，对于区分明确的PCP与其他HIV相关呼吸道疾病具有较高的准确性。
