Outcomes of HIV-associated pneumocystis pneumonia at a South African referral hospital.
Outcomes of HIV-associated pneumocystis pneumonia at a South African referral hospital.
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DOI：
10.1371/journal.pone.0201733
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Wasserman S
中科院分区：
文献类型：
--
作者：
Chiliza N;Du Toit M;Wasserman S
HIV 相关肺孢子虫肺炎 (PCP) 越来越被认为是撒哈拉以南非洲地区严重呼吸道疾病的重要原因。撒哈拉以南非洲地区尚未充分研究 HIV 感染 PCP 患者的结局，特别是那些需要入住重症监护病房 (ICU) 的患者。本研究的目的是描述一组南非住院患者中 HIV 相关 PCP 的临床表型和结果，并确定死亡率的预测因素。我们在开普敦的一个学术推荐中心进行了回顾性记录审查。年龄超过 18 岁且明确（任何阳性实验室检测）或可能患有 PCP（根据 WHO/CDC 临床病例定义）的 HIV 感染患者也包括在内。主要结局指标是 90 天死亡率。构建逻辑回归和 Cox 比例风险模型来确定与死亡率相关的因素。 2004年5月1日至2015年4月31日期间，我们筛选了562个测试请求；分析中纳入了 124 例 PCP 病例（68 例确诊病例，56 例疑似病例）。中位年龄为 34 岁（四分位距，IQR，29 至 41），89 名（72%）为女性，中位 CD4 细胞计数为 26 个细胞/mm3（IQR 12 至 70）。与入住病房的患者 (n = 82) 相比，入住 ICU 的患者 (n = 42) 的气体交换受损更严重（动脉氧与吸入氧的中位比 (PaO2:FiO2) 158 mmHg 与 243 mmHg，p < 0.0001），并且全身炎症标志物增加。 29 名 (23.6%) 患者在入院时新诊断出患有结核病。入住 ICU 的 26 名患者（61.9%）和普通病房的 21 名患者（25.9%）在入院后 90 天死亡。 90 天死亡率的显着预测因素包括 PaO2:FiO2 比率（aOR 3.7；95% CI，每降低 50 mgHg 1.1 至 12.9）、血清 LDH（aOR 2.1；95% CI，每增加 500 U/L 1.1 至 4.1）以及伴随抗结核治疗（aOR 82；95%） CI，1.9 至 3525.4；P = 0.021）。 PaO2:FiO2 < 100 mmHg 与住院患者死亡显着相关（aHR 3.8；95% CI，1.6 至 8.9；P = 0.003）。 HIV 相关 PCP 与严重的临床表型和结核病合并感染率较高有关。死亡率很高，特别是入住 ICU 的患者，但与其他环境相当。预后指标可用于为患有这种疾病的患者制定 ICU 入院政策。
HIV-associated pneumocystis pneumonia (PCP) is increasingly recognized as an important cause of severe respiratory illness in sub-Saharan Africa. Outcomes of HIV-infected patients with PCP, especially those requiring intensive care unit (ICU) admission, have not been adequately studied in sub-Saharan Africa. The aim of this study was to describe the clinical phenotype and outcomes of HIV-associated PCP in a group of hospitalized South African patients, and to identify predictors of mortality. We conducted a retrospective record review at an academic referral center in Cape Town. HIV-infected patients over the age of 18 years with definite (any positive laboratory test) or probable PCP (defined according to the WHO/CDC clinical case definition) were included. The primary outcome measure was 90-day mortality. Logistic regression and Cox proportional hazards models were constructed to identify factors associated with mortality. We screened 562 test requests between 1 May 2004 and 31 April 2015; 124 PCP cases (68 confirmed and 56 probable) were included in the analysis. Median age was 34 years (interquartile range, IQR, 29 to 41), 89 (72%) were female, and median CD4 cell count was 26 cells/mm3 (IQR 12 to 70). Patients admitted to the ICU (n = 42) had more severe impairment of gas exchange (median ratio of arterial to inspired oxygen (PaO2:FiO2) 158 mmHg vs. 243 mmHg, p < 0.0001), and increased markers of systemic inflammation compared to those admitted to the ward (n = 82). Twenty-nine (23.6%) patients were newly-diagnosed with tuberculosis during their admission. Twenty-six (61.9%) patients admitted to ICU and 21 (25.9%) admitted to the ward had died at 90-days post-admission. Significant predictors of 90-day mortality included PaO2:FiO2 ratio (aOR 3.7; 95% CI, 1.1 to 12.9 for every 50 mgHg decrease), serum LDH (aOR 2.1; 95% CI, 1.1 to 4.1 for every 500 U/L increase), and concomitant antituberculosis therapy (aOR 82; 95% CI, 1.9 to 3525.4; P = 0.021). PaO2:FiO2 < 100 mmHg was significantly associated with inpatient death (aHR 3.8; 95% CI, 1.6 to 8.9; P = 0.003). HIV-associated PCP was associated with a severe clinical phenotype and high rates of tuberculosis co-infection. Mortality was high, particularly in patients admitted to the ICU, but was comparable to other settings. Prognostic indictors could be used to inform ICU admission policy for patients with this condition.
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