Ewig S, Bauer T, Schneider C, Pickenhain A, Pizzulli L, Loos U, Lüderitz B
Department of Internal Medicine, University of Bonn, Germany.
Eur Respir J. 1995 Sep;8(9):1548-53.
The factors contributing to unequal mortality rates following Pneumocystis carinii pneumonia (PCP) in different groups at risk are poorly understood. We therefore compared the first episodes of PCP without prophylaxis in human immunodeficiency virus infected (HIV) and otherwise immunosuppressed patients in this retrospective study. A total of 58 HIV-infected and 16 otherwise immunosuppressed patients were analysed. The comparison included epidemiological, clinical, laboratory, radiological and microbiological data, as well as therapy and clinical course. A prognostic analysis was performed using a logistic regression model. The mortality was significantly different in the two groups (HIV group 17 versus non-HIV group 50%). Renal transplant patients had a higher survival rate as compared to malignancy or collagen vascular disease as underlying diseases at risk. Acute respiratory failure was more common in the non-HIV group. Variables found to be significantly associated with lethal outcome in univariate analysis were alveolar to arterial pressures difference for oxygen (P(A-a),O2), haemoglobin, platelet count, total protein, serum albumin, and gamma-globulins in the HIV-group, and serum albumin in the non-HIV group. In the multivariate analysis of the HIV group, platelet count and gamma-globulins remained independent prognostic factors. In conclusion, in the HIV-group, mortality is closely related to the severeness of PCP as well as to the severeness of the acquired immune deficiency syndrome (AIDS) disease. In the non-HIV group, malignancy and collagen vascular disease as underlying conditions at risk account for the high mortality rate. Its severeness was mainly reflected by serum albumin, which represented the only variable found to be significantly associated with death in both groups.
卡氏肺孢子虫肺炎（PCP）在不同风险组中导致死亡率不平等的因素尚不清楚。因此，在这项回顾性研究中，我们比较了未接受预防的人类免疫缺陷病毒（HIV）感染患者和其他免疫抑制患者首次发生的PCP情况。共分析了58例HIV感染患者和16例其他免疫抑制患者。比较内容包括流行病学、临床、实验室、放射学和微生物学数据，以及治疗和临床病程。使用逻辑回归模型进行预后分析。两组的死亡率有显著差异（HIV组为17%，非HIV组为50%）。与有潜在风险的恶性肿瘤或胶原血管疾病相比，肾移植患者的生存率更高。急性呼吸衰竭在非HIV组中更为常见。在单变量分析中发现与致命结局显著相关的变量，在HIV组中为氧的肺泡-动脉压差（P（A-a）O2）、血红蛋白、血小板计数、总蛋白、血清白蛋白和γ-球蛋白，在非HIV组中为血清白蛋白。在HIV组的多变量分析中，血小板计数和γ-球蛋白仍然是独立的预后因素。总之，在HIV组中，死亡率与PCP的严重程度以及获得性免疫缺陷综合征（AIDS）疾病的严重程度密切相关。在非HIV组中，有潜在风险的恶性肿瘤和胶原血管疾病是导致高死亡率的原因。其严重程度主要由血清白蛋白反映，血清白蛋白是两组中唯一与死亡显著相关的变量。
