Abstract
Purpose With immunosuppressants being widely used, Pneumocystis jirovecii pneumonia (PCP) has been increasing and could be life-threatening among HIV-negative patients. This study aimed at identifying prognostic factors of PCP in patients with nephrotic syndrome. Methods We retrospectively investigated patients with nephrotic syndrome who were diagnosed with PCP. The diagnosis of PCP was based on clinical manifestations, radiological findings, and microbiological confirmatory tests. Predictors of outcome were determined with multivariate logistic regression analysis. Results A total of 57 patients were included in this study. The PCP mortality was 33.3%, which increased to 48.6% if ICU admission was required and to 60% when mechanical ventilation was needed. The T lymphocyte count and CD4/CD8 ratio independently predicted the outcome of PCP, so did the CD4+ T lymphocyte count (OR, 0.981; 95% CI, 0.967–0.996; p=0.001). The cut-off value of 71 cells/μl for the CD4+ T lymphocyte count was determined to identify patients with poor prognosis. No association was found between PCP mortality and the type of immunosuppressant used. Conclusions PCP is a fatal complication among nephrotic syndrome patients receiving immunosuppressive therapy. The CD4+ T lymphocyte count is suggested as an independent predictor of prognosis, which can be used clinically to identify patients with high risk of unfavorable outcomes.
Highlights
Pneumocystis jirovecii pneumonia (PCP), a pulmonary infection caused by Pneumocystis jirovecii, has been recognized as a kind of common opportunistic infection among immunocompromised patients
While hematological malignancies and inflammatory diseases are considered as the main groups at risk of PCP, limited data are available in patients with nontransplant kidney diseases receiving immunosuppressants
Nephrotic syndrome, which include a group of renal diseases with diverse etiologies, was defined by the presence of heavy proteinuria, hypoalbuminemia, and peripheral edema [12]. e diagnosis of PCP was based on clinical manifestations, such as fever, dyspnea or progressive hypoxemia, radiological findings, such as typical bilateral ground glass opacity on chest computed tomography, and microbiological confirmatory tests
Summary
Pneumocystis jirovecii pneumonia (PCP), a pulmonary infection caused by Pneumocystis jirovecii, has been recognized as a kind of common opportunistic infection among immunocompromised patients. Since the early 2000s, more and more PCPs have been diagnosed among HIV-negative patients as the use of immunosuppressive agents increases in treating malignancies, autoimmune disorders, and inflammatory diseases, as well as in solid organ transplants [2,3,4]. Cases of PCP have been reported in patients with nephrotic syndrome [10, 11], but there are a few systemic investigations of PCP mortality among this group of people. We aimed to assess the prognostic factors of PCP in patients with nephrotic syndrome by Canadian Journal of Infectious Diseases and Medical Microbiology analyzing cases of PCP that occurred in this population from 2013 to 2018 in our institution with standardized methods of diagnosis and management
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