CHEST
Clinical InvestigationsPrognostic Markers of Short-term Mortality in AIDS-Associated Pneumocystis carinii Pneumonia
Section snippets
Patients
Between June 1, 1990, and January 31, 1999, all episodes of HIV-1-related PCP diagnosed at the Department of Infectious Diseasesat Hvidovre Hospital, Copenhagen, were included in the study. Clinicaland laboratory data were collected prospectively. Outcome was recordedfrom the medical files.
A diagnosis of PCP was established by bronchoscopy with BAL aspreviously described.25 BAL fluid was divided intoaliquots for microbiological and cytologic examination, including aGram's stain and cultures for
Patient Characteristics
During the study period, there were 189 episodes of confirmed PCPin 176 individuals. As shown in Table 1, the majority of patients were male (94%), had had sex with men(70%), and presented with PCP as a first diagnosis of AIDS (88%). Forty-five percent had HIV-1 diagnosed at the same time as theirdiagnosis of PCP. Sixteen patients had a previous diagnosis of PCP. Fewpatients were treated with antiretroviral therapy at the time of PCP(20%).
Laboratory Characteristics at Admission
Measures of Po2 and Pco2, on room air, were 65 mm
Discussion
In this study, we show that age, initial anti-PCP therapy, use of PCP prophylaxis, and BAL CMV status may be useful markers foridentification of patients with a severe prognosis. Surprisingly, classic markers such as Po2 and serumLDH did not have independent prognostic value.
The choice of initial antimicrobial therapy (IV pentamidine) wasassociated with a threefold increased risk of death. Trimetrexate orclindamycin/primaquine was associated with an increased RR of progression to death as well,
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Cited by (60)
Pulmonary Manifestations of Human Immunodeficiency Virus Infection
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious DiseasesPrognostic factors of Pneumocystis jirovecii pneumonia in patients without HIV infection
2014, Journal of InfectionCitation Excerpt :Prognostic factors for HIV PCP have been well-established. In HIV PCP, frequently reported markers of poor prognosis either at the time of diagnosis or during treatment are age, low serum albumin and bilirubin, high LDH levels, hypoxemia <60 mmHg, high alveolar–arterial oxygen gradient (D[A–a]O2), high percentage of neutrophils in bronchoalveolar lavage (BAL) fluid, use of PCP prophylaxis, and BAL cytomegalovirus (CMV) status.5–12 Despite the more severe course and poor prognosis of non-HIV PCP, only a few studies have reported any prognostic factors of non-HIV PCP, and most of these have had a small sample size or only included a univariate analysis.2,13,14
Early diagnosis and treatment are crucial for the survival of Pneumocystis pneumonia patients without human immunodeficiency virus infection
2012, Journal of Infection and ChemotherapyMassive alveolar hemorrhage due to cytomegalovirus (CMV) and HIV infection
2011, Medicina IntensivaPneumonia in the immunocompromised patient
2010, Medicine
Supported by grants from the Danish Medical Research Council(Nos. 9400576 and 12–1451-1) and the Danish AIDS Foundation.