Adjunctive Corticosteroids Decreased the Risk of Mortality of Non-HIV Pneumocystis Pneumonia

Abstract

Background A mortality rate of non-human immunodeficiency virus-infected pneumocystis pneumonia (non-HIV PCP) is 30-60%, but the effectiveness of adjunctive corticosteroids with trimethoprim-sulfamethoxazole has not yet been adequately examined. To determine whether adjunctive corticosteroids with trimethoprim-sulfamethoxazole is associated with decreasing the mortality rate of non-HIV PCP. Methods We did database observational study of adult non-HIV PCP patients from April 2010 through March 2016, using Japanese nationwide healthcare records of the Diagnostic Procedure Combination database. The primary outcome was the 60-day mortality risk estimated by the time-dependent Cox regression analyses with inverse probability weights. Findings 1299 eligible non-HIV PCP patients were identified. 737 patients were severe respiratory status (partial pressure of oxygen in arterial blood [PaO2] ≤60 mm Hg) and 562 were moderate (PaO2 >60 mm Hg) at hospital admission. Among patients with severe respiratory status, the adjunctive corticosteroids was associated with lower risk of 60-day mortality (HR 0.68; 95% confidence interval [CI], 0.51-0.92), and significantly decreased mortality rates (24.7% vs 36.6%, P=.012). In contrast, among patients with moderate respiratory status, the adjunctive corticosteroids was not significantly associated with lower risk of 60-day mortality (HR 1.10; 95% CI, 0.71-1.71) and no significant difference was observed in 60-day mortality rate (10.9% in Adjunctive Corticosteroids group vs 9.1% in TMP-SMX only group; P = .67). Interpretation The adjunctive corticosteroids with TMP-SMX was associated with lower risk of 60-day mortality in severe non-HIV PCP patients. Funding: Ministry of Health, Labour and Welfare; JSPS. Declaration of Interest: The authors declare no conflicts of interest associated with this manuscript. Ethical Approval: The study was approved by the Institutional Review Board at Tokyo Medical and Dental University (M2000-788).