Abstract
BackgroundHigh-dose steroid therapy has been proven effective in AIDS-related Pneumocystis pneumonia (PCP) but not in non-AIDS-related cases. We evaluated the effects on survival of steroids in HIV-negative patients with PCP.MethodsRetrospective study patients admitted to the ICU with hypoxemic PCP. We compared patients receiving HDS (≥1 mg/Kg/day prednisone equivalent), low-dose steroids (LDS group, <1 mg/Kg/day prednisone equivalent), and no steroids (NS group). Variables independently associated with ICU mortality were identified.Results139 HIV-negative patients with PCP were included. Median age was 48 [40–60] years. The main underlying conditions were hematological malignancies (n=55, 39.6%), cancer (n=11, 7.9%), and solid organ transplantation (n=73, 52.2%). ICU mortality was 26% (36 deaths). The HDS group had 72 (51.8%) patients, the LDS group 35 (25%) patients, and the NS group 32 (23%) patients. Independent predictors of ICU mortality were SAPS II at ICU admission (odds ratio [OR], 1.04/point; [95%CI], 1.01-1.08, P=0.01), non-hematological disease (OR, 4.06; [95%CI], 1.19-13.09, P=0.03), vasopressor use (OR, 20.31; 95%CI, 6.45-63.9, P<0.001), and HDS (OR, 9.33; 95%CI, 1.97-44.3, P=0.02). HDS was not associated with the rate of ICU-acquired infections.ConclusionsHDS were associated with increased mortality in HIV-negative patients with PCP via a mechanism independent from an increased risk of infection.
Highlights
Pneumocystis jiroveci pneumonia (PCP) is a major cause of acute respiratory failure in immunocompromised patients
Independent predictors of intensive care unit (ICU) mortality were SAPS II at ICU admission, non-hematological disease (OR, 4.06; [95%CI], 1.19-13.09, P=0.03), vasopressor use (OR, 20.31; 95%CI, 6.45-63.9, P
HDS were associated with increased mortality in Human immunodeficiency virus (HIV)-negative patients with Pneumocystis pneumonia (PCP) via a mechanism independent from an increased risk of infection
Summary
Pneumocystis jiroveci pneumonia (PCP) is a major cause of acute respiratory failure in immunocompromised patients. Steroid treatment, and transplantation of solid organs or bone marrow are the leading causes of T-cell suppression, which is associated with a high risk of opportunistic infections, including PCP [1]. The number of patients with T-cell suppression has risen in recent years, resulting in an increased incidence of PCP [2,3]. More than 8% of patients with hematological malignancies admitted to the ICU for acute respiratory failure had PCP [4]. High-dose steroid therapy has been proven effective in AIDS-related Pneumocystis pneumonia (PCP) but not in non-AIDS-related cases. We evaluated the effects on survival of steroids in HIV-negative patients with PCP
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