Gentile G, Donati P P, Capobianchi A, Rolli M, Iori A P, Martino P
Department of Human Biopathology, University La Sapienza, Rome, Italy.
J Infect. 1997 Sep;35(2):117-23. doi: 10.1016/s0163-4453(97)91446-8.
We verified whether a clinical score system developed for renal transplant patients predicts the severity and outcome of cytomegalovirus interstitial pneumonia (CMV IP) in allogeneic bone marrow (BMT) recipients. The score system was retrospectively applied to 20 patients at the estimated date of onset of IP and 10-14 days later. Seven patients received ganciclovir (GCV), seven received GCV plus intravenous immunoglobulin (i.v. Ig), and six received only supportive care. Nine out of 14 patients who received GCV with or without i.v. Ig survived the episode of IP (the median score of these patients at diagnosis of CMV IP was 5 (range 3-8)), while the remaining five patients died of respiratory failure during IP and at the diagnosis had a median score of 10 (range 9-11) (P=0.01). The six patients who received only supportive care survived for a median time of 21 days (range 10-24 days) from the estimated onset of CMV IP, and the median score at the diagnosis of IP was 10 (range 8-12). The overall survival correlates strongly with low initial severity of IP as measured by this score system: 11 out of 20 patients who died of respiratory failure during IP had at the estimated onset of IP a score >8, while of the nine patients who survived IP, eight had at the onset a score <7 and the remaining one a score of 8 (P=0.0007). The sensibility, specificity, predictive positive value and predictive negative value of the score system (with a threshold value of 8) to identify patients who survived IP was: 100%, 88%, 91% and 100%, respectively. The use of ganciclovir alone or in combination was the most important determinant of outcome. These data support the relevance of this score system with a threshold value of 8; if prospective and controlled studies confirm our observations, it would help physicians to identify BMT recipients during CMV IP with high vs. low risk of poor outcome.
我们验证了一种为肾移植患者开发的临床评分系统是否能预测异基因骨髓移植（BMT）受者中巨细胞病毒间质性肺炎（CMV IP）的严重程度和预后。该评分系统在预计的IP发病日期及10 - 14天后回顾性应用于20例患者。7例患者接受更昔洛韦（GCV）治疗，7例接受GCV加静脉注射免疫球蛋白（i.v. Ig）治疗，6例仅接受支持治疗。在接受GCV治疗（无论是否联合i.v. Ig）的14例患者中，9例在IP发作期存活（这些患者在诊断CMV IP时的中位评分为5分（范围3 - 8分）），而其余5例患者在IP期间死于呼吸衰竭，诊断时的中位评分为10分（范围9 - 11分）（P = 0.01）。仅接受支持治疗的6例患者从预计的CMV IP发病起存活的中位时间为21天（范围10 - 24天），IP诊断时的中位评分为10分（范围8 - 12分）。总体生存率与通过该评分系统测量的IP初始低严重程度密切相关：在IP期间死于呼吸衰竭的20例患者中，11例在预计的IP发病时评分>8分，而在存活IP的9例患者中，8例在发病时评分<7分，其余1例评分为8分（P = 0.0007）。该评分系统（阈值为8）识别存活IP患者的敏感性、特异性、预测阳性值和预测阴性值分别为：100%、88%、91%和100%。单独或联合使用更昔洛韦是预后的最重要决定因素。这些数据支持阈值为8的该评分系统的相关性；如果前瞻性对照研究证实我们的观察结果，它将有助于医生识别CMV IP期间预后不良风险高与低的BMT受者。
