Characteristics and prognosis factors of Pneumocystis jirovecii pneumonia according to underlying disease: a retrospective multicentre study.
Corticosteroids
Immune-Mediated Inflammatory Diseases
Outcome
Pneumocystis jirovecii pneumonia
Solid Tumors
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
10 Jan 2024
10 Jan 2024
Historique:
received:
11
10
2023
revised:
15
12
2023
accepted:
05
01
2024
medline:
13
1
2024
pubmed:
13
1
2024
entrez:
12
1
2024
Statut:
aheadofprint
Résumé
Pneumocystis jirovecii pneumonia (PcP) remains associated with high rates of mortality and the impact of immunocompromising underlying disease on the clinical presentation, severity and mortality of PcP has not been adequately evaluated. Does the underlying disease and immunosuppression causing Pneumocystis jirovecii pneumonia (PcP) impact the outcome and clinical presentation of the disease? In this multicentre retrospective observational study, conducted from January 2011 to December 2021, all consecutive patients admitted with a proven or probable diagnosis of PcP according to The European Organization for Research and Treatment of Cancer (EORTC) consensus definitions were included to assess the epidemiology and impact of underlying immunosuppressive diseases on overall and 90-day mortality. Overall, 481 patients were included in the study, 180 (37.4%) were defined as proven PcP and 301 (62.6%) as probable PcP. Patients with immune-mediated inflammatory diseases (IMID) or solid tumors had a statistically poorer prognosis than other patients with PcP at D90. In multivariate analysis, among HIV-negative population, solid tumor underlying disease (OR 5.47, 2.16-14.1; p<0.001), IMID (OR 2.19, 1.05-4.60; p=0.037), long term corticosteroid exposure (OR 2.07, 1.03-4.31; p=0.045), cysts in sputum/BAL smears (OR 1.92, 1.02-3.62; p=0.043), and SOFA score at admission (OR 1.58, 1.39-1.82; p<0.001) were independently associated with 90-day mortality. Prior corticotherapy was the only immunosuppressant associated with 90-day mortality (OR 1.67, 1.03-2.71; p=0.035), especially for a prednisone daily dose ≥ 10 mg (OR 1.80, 1.14-2.85; p=0.010). Among HIV-negative patients, long term corticosteroid prior to PcP diagnosis was independently associated with increased 90-day mortality, specifically in IMID patients. These results highlight both the needs for PcP prophylaxis in IMID patients as well as to early consider PcP curative treatment in severe pneumonia among IMID patients.
Sections du résumé
BACKGROUND
BACKGROUND
Pneumocystis jirovecii pneumonia (PcP) remains associated with high rates of mortality and the impact of immunocompromising underlying disease on the clinical presentation, severity and mortality of PcP has not been adequately evaluated.
RESEARCH QUESTION
OBJECTIVE
Does the underlying disease and immunosuppression causing Pneumocystis jirovecii pneumonia (PcP) impact the outcome and clinical presentation of the disease?
STUDY DESIGN AND METHODS
METHODS
In this multicentre retrospective observational study, conducted from January 2011 to December 2021, all consecutive patients admitted with a proven or probable diagnosis of PcP according to The European Organization for Research and Treatment of Cancer (EORTC) consensus definitions were included to assess the epidemiology and impact of underlying immunosuppressive diseases on overall and 90-day mortality.
RESULTS
RESULTS
Overall, 481 patients were included in the study, 180 (37.4%) were defined as proven PcP and 301 (62.6%) as probable PcP. Patients with immune-mediated inflammatory diseases (IMID) or solid tumors had a statistically poorer prognosis than other patients with PcP at D90. In multivariate analysis, among HIV-negative population, solid tumor underlying disease (OR 5.47, 2.16-14.1; p<0.001), IMID (OR 2.19, 1.05-4.60; p=0.037), long term corticosteroid exposure (OR 2.07, 1.03-4.31; p=0.045), cysts in sputum/BAL smears (OR 1.92, 1.02-3.62; p=0.043), and SOFA score at admission (OR 1.58, 1.39-1.82; p<0.001) were independently associated with 90-day mortality. Prior corticotherapy was the only immunosuppressant associated with 90-day mortality (OR 1.67, 1.03-2.71; p=0.035), especially for a prednisone daily dose ≥ 10 mg (OR 1.80, 1.14-2.85; p=0.010).
INTERPRETATION
CONCLUSIONS
Among HIV-negative patients, long term corticosteroid prior to PcP diagnosis was independently associated with increased 90-day mortality, specifically in IMID patients. These results highlight both the needs for PcP prophylaxis in IMID patients as well as to early consider PcP curative treatment in severe pneumonia among IMID patients.
Identifiants
pubmed: 38215935
pii: S0012-3692(24)00022-9
doi: 10.1016/j.chest.2024.01.015
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Inc.