Hospitalization Outcomes in Pneumocystis Pneumonia Inpatient Population: A Comparison between HIV and Non-HIV Patients.

Sorabh Datta,Priya Patel,Bipin Saroha,Shanan Mahal,Ehinor E Isidahome,Virendrasinh Ravat

doi:10.7759/cureus.3082

Abstract

ObjectiveTo evaluate the difference in hospitalization outcomes, including morbidity and mortality among patients admitted for Pneumocystis pneumonia (PCP) with human immunodeficiency virus (HIV) and non-HIV condition.MethodsA case-control study was done using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) data. We identified PCP and HIV as the primary and secondary diagnosis using ICD-9-CM diagnosis codes. We used the multinomial logistic regression model to generate odds ratios (OR).ResultsA total number of 1250 PCP patients were enrolled in this retrospective analysis. PCP patients with HIV had eight times higher odds of non-elective admission based on emergency condition (OR = 7.873, P < .001) compared to non-HIV patients. PCP patients with HIV had eight times higher odds of longer hospitalization of more than eight days (OR = 8.687, P < .001) compared to non-HIV patients. HIV patients with PCP had five times higher odds of severe morbidity or extreme loss of body function (OR = 5.277, P < .001). PCP patients with HIV had 22 times higher likelihood of in-hospital mortality (OR = 21.845, P < .001) compared to non-HIV patients.ConclusionPCP patients with HIV have a higher risk of severe morbidity and in-hospital mortality as compared to non-HIV patients. More attention needs to be paid to the elderly population that is at a higher risk of PCP with HIV. We need additional research and studies to direct the development of clinical care models for aiming early diagnosis and treatment of HIV in PCP patients.

Highlights

Pneumocystis pneumonia (PCP) is an opportunistic infection of the lung caused by the fungus Pneumocystis jirovecii [1]
PCP patients with human immunodeficiency virus (HIV) had eight times higher odds of non-elective admission based on emergency condition (OR = 7.873, P < .001) compared to non-HIV patients
PCP is a common opportunistic infection among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in developing countries [3]

Summary

Introduction

Pneumocystis pneumonia (PCP) is an opportunistic infection of the lung caused by the fungus Pneumocystis jirovecii [1]. PCP is a common opportunistic infection among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in developing countries [3]. HIV-infected patients with a low CD4 count are at the highest risk of PCP. Others at substantial risk include hematopoietic cell and solid organ transplant recipients, those with cancer ( hematologic malignancies), and those receiving glucocorticoids, chemotherapeutic agents, and other immunosuppressive medications. The incidence of PCP is increasing as the number of people receiving immunosuppressive medications continues to grow [4]. The incidence of PCP appears to vary by underlying condition, as in hematologic malignancies it is 32.5%, 18.2% in solid tumors, 14.9% in inflammatory diseases, and 12.3% in solid organ transplant [5]. The reported rates vary with underlying disease and immunosuppressive regimen, it is 22%–45% in children with acute lymphoblastic leukemia without prophylaxis, which decreases to 0% with prophylaxis, 25% among patients with Hodgkin lymphoma without

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