Abstract
Objective. To identify blood biomarkers to predict severity and mortality in AIDS PCP patients. Methods. Biomarkers including clinical parameters and plasma inflammatory cytokines were assessed in 32 HIV-infected patients with Pneumocystis pneumonia (PCP) at time of admission. Predictive value of the biomarkers for clinical severity and in-hospital mortality was evaluated by corresponding ROC curve. Results. Levels of CRP, WBC, LDH, HBDH, and Ferritin were significantly higher in the severe and nonsurvivor AIDS PCP patients. These important biochemical indicators have inverse correlation with oxygenation index, especially levels of LDH (P = 0.008, R 2 = 0.258), HBDH (P = 0.001, R 2 = 0.335), and Ferritin (P = 0.005, R 2 = 0.237). Plasma IL-8 and IL-6 levels were significantly higher in patients with PaO2/FiO2 ≤ 200 mmHg and nonsurvivors than in those with PaO2/FiO2 > 200 mmHg and survivors. Severe and nonsurvival groups showed higher ratio of mean IL-6/IL-10 level (1.78 ± 1.56, P < 0.001; 1.11 ± 0.72, P = 0.043), larger AUC (95% CI 0.781–1.000, P < 0.001; 95% CI 0.592–0.917, P = 0.043), and more significantly inverse correlation with the oxygenation index. Conclusion. Plasma IL-8, LDH, and HBDH levels and IL-6/IL-10 ratio could be helpful for early evaluation of the severity and predicting fatal outcomes in AIDS PCP patients.
Highlights
Pneumocystis pneumonia (PCP) is one of the most common opportunistic infections in HIV-infected patients with a substantial mortality rate
Diagnosis of PCP was based on the combination of symptoms, signs, laboratory data, arterial oxygenation at rest, and computed tomography (CT), including subacute onset of unproductive cough, fever, progressive dyspnea, and chest discomfort that worsens within days to weeks; arterial partial pressure of oxygen (PaO2) lower than 65 mmHg at time admission; and elevated level of lactate dehydrogenase (>245 U/L)
None of the patients had taken PCP prophylaxis prior to admission and 90.6% were naive to antiretroviral therapy (ART)
Summary
Pneumocystis pneumonia (PCP) is one of the most common opportunistic infections in HIV-infected patients with a substantial mortality rate. A recent cohort study in China by Xiao et al found that the top three most common opportunistic infections (OI) of hospitalized HIV-infected patients were tuberculosis (32.5%), candidiasis (29.3%), and PCP (2.4%), with PCP resulting in an in-hospital mortality rate of 33.1% [1]. The incidence of PCP has declined with combination of antiretroviral therapy (ART) and PCP prophylaxis. PCP may occur in patients who are unaware of their HIV infection, are unable to reach medical care, or fail to adhere to PCP prophylaxis or ART [1, 2]. Diagnosis of PCP in AIDS patients can be challenging, especially when the CD4 count is unknown; empiric therapy is often initiated based upon nonspecific clinical manifestations while awaiting the results of diagnostic tests [3]
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