Lower Mortality Associated With Adjuvant Corticosteroid Therapy in Non-HIV-Infected Patients With Pneumocystis jirovecii Pneumonia: A Single-Institution Retrospective US Cohort Study.

Autor: Mundo W; School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.; School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Morales-Shnaider L; Graduate School, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Tewahade S; School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Wagner E; School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Archuleta S; School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Bandali M; School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Chadalawada S; Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Johnson SC; Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA., Franco-Paredes C; School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.; NRI Medical College, NRI General Hospital, Guntur, Andhra Pradesh, India.; Hospital Infantil de México, Federico Gómez, México City, México., Shapiro L; NRI Medical College, NRI General Hospital, Guntur, Andhra Pradesh, India.; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.; The Emily Foundation for Medical Research, Boston, Massachusetts, USA., Henao-Martínez AF; School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.; NRI Medical College, NRI General Hospital, Guntur, Andhra Pradesh, India.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2020 Aug 13; Vol. 7 (9), pp. ofaa354. Date of Electronic Publication: 2020 Aug 13 (Print Publication: 2020).
DOI: 10.1093/ofid/ofaa354
Abstrakt: Background: Pneumocystis jirovecii pneumonia (PJP) remains a cause of mortality in HIV-negative patients. The clinical benefit of adjuvant corticosteroids in these patients is uncertain. This study aimed to determine if corticosteroids would reduce mortality in a cohort of HIV-negative PJP patients.
Methods: We examined a retrospective case series of patients diagnosed with PJP at the University of Colorado Hospital between 1995 and 2019. Data were collected in 71 PJP-infected patients. Twenty-eight patients were HIV-negative, and 43 were infected with HIV. We performed bivariate and forward, stepwise multivariable logistic regressions to identify mortality predictors.
Results: Common underlying conditions in HIV-negative patients were hematologic malignancies (28.6%), autoimmune disorders (25.9%), and solid organ transplantation (10.7%). HIV-negative patients had higher rates and durations of mechanical ventilation and intensive care unit stay. Survival was significantly increased in HIV-negative patients receiving adjuvant corticosteroids, with 100% mortality in patients not receiving corticosteroids vs 60% mortality in patients receiving corticosteroids ( P = .034). In an adjusted multivariable model, no adjuvant corticosteroid use was associated with higher mortality (odds ratio, 13.5; 95% CI, 1.1-158.5; P = .039) regardless of HIV status.
Conclusions: We found substantial mortality among HIV-negative patients with PJP, and adjuvant corticosteroid use was associated with decreased mortality. Response to corticosteroids is best established in HIV-infected patients, but emerging reports suggest a similar beneficial response in PJP patients without HIV infection. Further prospective studies may establish a more definitive role of the addition of corticosteroids among HIV-negative patients with PJP.
(© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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