Lower Mortality Associated With Adjuvant Corticosteroid Therapy in Non-HIV-Infected Patients With Pneumocystis jirovecii Pneumonia: A Single-Institution Retrospective US Cohort Study
| Autor: | Andrés F. Henao-Martínez, Louis Morales-Shnaider, Steven C. Johnson, Mohamed Bandali, Solana Archuleta, William Mundo, Leland Shapiro, Selam Tewahade, Eric Wagner, Sindhu Chadalawada, Carlos Franco-Paredes |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty medicine.medical_treatment 030106 microbiology retrospective corticosteroid adjuvant therapy Major Articles law.invention 03 medical and health sciences 0302 clinical medicine law Internal medicine medicine 030212 general & internal medicine Prospective cohort study Mechanical ventilation business.industry HIV negative Odds ratio medicine.disease Pneumocystis jirovecii pneumonia Intensive care unit Pneumonia AcademicSubjects/MED00290 Infectious Diseases Oncology Cohort prognosis business Adjuvant Cohort study |
| Zdroj: | Open Forum Infectious Diseases |
| ISSN: | 2328-8957 |
| DOI: | 10.1093/ofid/ofaa354 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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