Host Factors and Outcomes in Hospitalizations for Pneumocystis Jirovecii Pneumonia in the United States.

Autor:	Kanj A; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN., Samhouri B; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN., Abdallah N; Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN., Chehab O; Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, MI., Baqir M; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: Baqir.Misbah@mayo.edu.
Jazyk:	angličtina
Zdroj:	Mayo Clinic proceedings [Mayo Clin Proc] 2021 Feb; Vol. 96 (2), pp. 400-407.
DOI:	10.1016/j.mayocp.2020.07.029
Abstrakt:	Objective: To assess host factors in pneumocystis jirovecii pneumonia (PCP)-related hospitalizations and compare outcomes between HIV and non-HIV patients. Methods: Using the National Inpatient Sample database, we identified 3384 hospitalizations with PCP (International Classification of Diseases, Ninth Revision, Clinical Modification code: 136.3) as the primary discharge diagnosis from 2005 to 2014. We evaluated hospitalizations for the following host factors: HIV, malignancies, organ transplantation, rheumatologic diseases, and vasculitides. We compared the prevalence of individual host factors among PCP hospitalizations over time, and compared intervention rates and outcomes between HIV and non-HIV patients with PCP. Results: Among all hospitalizations for PCP, malignancy was the most prevalent host factor (46.0%, n=1559), followed by HIV (17.8%, n=604); 60.7% (n=946) of malignancies were hematologic. The prevalence of HIV among hospitalizations for PCP decreased from 25.1% in 2005 to 9.2% in 2014 (P<.001), whereas the prevalence of non-HIV immunocompromising conditions increased. Compared with HIV patients, PCP patients without HIV had higher rates of bronchoscopy (52.3% vs 26.7%, P<.001) and endotracheal intubation (17.0% vs 7.9%, P<.001), prolonged hospitalizations (11.5 vs 8.7 days, P<.001), higher hospitalization costs (86.8 vs 48.2×10 3 USD, P<.001) and increased in-hospital mortality (16.0% vs 5.0%, P<.001). After adjusting for age, sex, and smoking status, there was no difference in mortality between non-HIV and HIV patients with PCP (adjusted odds ratio, 1.4; 95% CI, 0.9 to 2.3). Conclusion: The epidemiology of PCP has shifted with an increase in the prevalence of non-HIV patients who have higher intubation rates and prolonged hospitalizations compared with matched HIV patients. (Copyright © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu