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Volume 44, Number 4, August 2011

Mortality predictors of Pneumocystis jirovecii pneumonia in human immunodeficiency virus-infected patients at presentation: Experience in a tertiary care hospital of northern Taiwan


Hsiao-Wei Wang, Cheng-Chih Lin, Chen-Feng Kuo, Chang-Pan Liu, Chun-Ming Lee


Received: April 20, 2010    Revised: June 25, 2010    Accepted: August 12, 2010   

 

Corresponding author:

 Division of Infectious Disease, Department of Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chungshan North Rd, Taipei, Taiwan. E-mail address: idwang6366@gmail.com (C.-M. Lee)



 

Background and purpose: 

Pneumocystis jirovecii pneumonia (PJP) remains the leading cause of opportunistic infections and deaths among human immunodeficiency virus (HIV)-infected patients. We would like to identify the predictors of mortality of these patients at initial presentation, and assist clinicians to aware the patients in risk of mortality earlier.



 

Methods:

From 1997 to 2009, adults with HIV infection and a discharge diagnosis of PJP at Mackay Memorial Hospital were included in this retrospective study. Patients’ demographic data and laboratory data were analyzed by reviewing the medical records.



 

Results:

Eighty-five patients were included in this study. The overall mortality rate was 37.7%. Univariate analysis revealed several host factors significantly related to mortality, including age, systolic blood pressure, diastolic blood pressure, partial pressure of oxygen in arterial blood (PaO2), percentage of lymphocyte, percentage of CD4 lymphocyte, CD4 counts, serum total protein, serum albumin, and blood urea nitrogen. Multivariate analysis identified three independent predictors associated with mortality, i.e. systolic blood pressure ≤110 mmHg [adjusted odds ratio (AOR) 3.88; 95% confidence interval (CI) 1.17–12.83; p = 0.03], PaO2 at room air ≤60 mmHg (AOR 4.97; 95% CI 1.34–18.23; p = 0.01), and lymphocytes ≤10% (AOR 8.19; 95% CI 1.48–45.36; p = 0.02). With these predictors, we can stratify patients into three groups with increasing risks for mortality, ≤one predictor (mortality rate 14%), any two predictors (47%), and three predictors (75%).



 

Conclusion:

HIV-infected patients with PJP can be clinically stratified by three prognostic variables identified by multivariate analysis. Early recognition of patients in higher risk can assist clinicians to prevent rapid deterioration and seek for better outcomes.



 

Key words:

 Acquired immunodeficiency syndromes, Highly active antiretroviral therapy, Human immunodeficiency virus, Mortality, Pneumocystis jirovecii pneumonia