CD4+T cell lymphopenia predicts mortality fromPneumocystispneumonia in kidney transplant patients

Autor: Volkmar Jacobi, Stefan Büttner, Helmut Geiger, Aida Asbe-Vollkopf, Tilo Freiwald, Simon S. Martin, Ingeborg A. Hauser, Despina Avaniadi, Eva Herrmann, Christoph Stephan, Rainer U. Pliquett, Nardos T. Cheru, Gundolf Schüttfort
Rok vydání: 2020
Předmět:
Zdroj: Clinical Transplantation. 34
ISSN: 1399-0012
0902-0063
DOI: 10.1111/ctr.13877
Popis: Background Pneumocystis jirovecii pneumonia (PcP) remains a life-threatening opportunistic infection after solid organ transplantation, even in the era of Pneumocystis prophylaxis. The association between risk of developing PcP and low CD4+ T cell counts has been well established. However, it is unknown whether lymphopenia in the context of post-renal transplant PcP increases the risk of mortality. Methods We carried out a retrospective analysis of a cohort of kidney transplant patients with PcP (n = 49) to determine the risk factors for mortality associated with PcP. We correlated clinical and demographic data with the outcome of the disease. For CD4+ T cell counts, we used the Wilcoxon rank sum test for in-hospital mortality and a Cox proportional-hazards regression model for 60-day mortality. Results In univariate analyses, high CRP, high neutrophils, CD4+ T cell lymphopenia, mechanical ventilation, and high acute kidney injury network stage were associated with in-hospital mortality following presentation with PcP. In a receiver-operator characteristic (ROC) analysis, an optimum cutoff of ≤200 CD4+ T cells/µL predicted in-hospital mortality, CD4+ T cell lymphopenia remained a risk factor in a Cox regression model. Conclusions Low CD4+ T cell count in kidney transplant recipients is a biomarker for disease severity and a risk factor for in-hospital mortality following presentation with PcP.
Databáze: OpenAIRE
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