Vanhems P, Toma E
Department of Social and Preventive Medicine, University of Montreal.
Chest. 1995 Jan;107(1):107-12. doi: 10.1378/chest.107.1.107.
(1) To evaluate a clinical score predicting the early death from Pneumocystis carinii pneumonia (PCP) in HIV-infected patients and to compare it with lactate dehydrogenase (LDH) levels and Karnofsky's performance score. (2) To compare the association of this score and partial oxygen pressure (PaO2) at baseline (at ambiant air) with change in therapy.
This clinical score was based on respiratory rate, degree of fever, cough, dyspnea, chest tightness, and chest radiographic findings. It was prospectively assessed in patients enrolled in two clinical trials for primary therapy of PCP.
A university hospital with a large AIDS population.
PCP scores (PCPSc) were assessed on treatment days (D) 0, D3, D7, D14, and D21 for 78 patients with mild to moderately severe PCP (PaO2 > 50 mm Hg at entry at room air). Regardless of the treatment received, these patients were stratified into two groups (survivors and nonsurvivors) within 45 days after the beginning of therapy.
The PCPSc was associated with 45 days survival at treatment D3 (p = 0.03) and D14 (p < 0.001). Its decrease was significant between D0 and D7 and between D7 and D14 for survivors only. The LDH levels during the treatment course did not correlate with outcome. The fall in LDH values was significant only for survivors between D7 and D14 of therapy. The PaO2 at hospital admission was associated with death at 45 days and was well correlated with the PCPSc on D0 by single and multiple linear regression (R = 0.60, p < 0.0001). The PCPsc on D0 was associated with the change of initial therapy due to failure or drug adverse effects whereas PaO2 on D0 was associated only with treatment failure.
For HIV-infected patients with mild to moderately severe PCP, this clinical score is easy to assess and has a prognostic value for survivors. It could be helpful to predict both treatment failure and occurrence of severe adverse drug reactions. The PCPSc should be validated in a larger number of patients, including those with more severe forms of PCP.
（1）评估一种预测HIV感染患者卡氏肺孢子虫肺炎（PCP）早期死亡的临床评分，并将其与乳酸脱氢酶（LDH）水平及卡诺夫斯基体能状态评分进行比较。（2）比较该评分及基线时（在室内空气中）的动脉血氧分压（PaO2）与治疗变化之间的关联。
该临床评分基于呼吸频率、发热程度、咳嗽、呼吸困难、胸闷及胸部X线检查结果。对纳入两项PCP初始治疗临床试验的患者进行前瞻性评估。
一家拥有大量艾滋病患者的大学医院。
对78例轻度至中度严重PCP患者（入室空气时PaO2>50 mmHg）在治疗第0、3、7、14和21天评估PCP评分（PCPSc）。无论接受何种治疗，这些患者在治疗开始后45天内被分为两组（存活者和非存活者）。
PCPSc与治疗第3天（p = 0.03）和第14天（p < 0.001）的45天生存率相关。仅存活者在第0天和第7天之间以及第7天和第14天之间其下降显著。治疗过程中的LDH水平与预后无关。仅存活者在治疗第7天和第14天之间LDH值下降显著。入院时的PaO2与45天死亡率相关，通过单因素和多因素线性回归分析，其与第0天的PCPSc密切相关（R = 0.60，p < 0.0001）。第0天的PCPSc与因治疗失败或药物不良反应导致的初始治疗变化相关，而第0天的PaO2仅与治疗失败相关。
对于轻度至中度严重PCP的HIV感染患者，该临床评分易于评估，对存活者具有预后价值。它有助于预测治疗失败及严重药物不良反应的发生。PCPSc应在更多患者中进行验证，包括那些PCP病情更严重的患者。
