Early predictors of mortality from Pneumocystis jirovecii pneumonia in HIV-infected patients:: 1985-2006
Early predictors of mortality from Pneumocystis jirovecii pneumonia in HIV-infected patients:: 1985-2006
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DOI：
10.1086/526778
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发表时间：
2008-02-15
影响因子：
11.8
通讯作者：
Miller, Robert F.
中科院分区：
文献类型：
--
作者：
Walzer, Peter D.;Evans, Hannah E. R.;Miller, Robert F.
背景耶氏肺孢子虫肺炎（PCP）仍然是人类免疫缺陷病毒（HIV）感染者机会性感染的主要原因。以前的PCP研究确定了病例死亡风险因素，涉及少数患者，进行了几年，通常集中在重症监护病房的患者。本研究的目的是确定从1985年6月至2006年6月在伦敦大学学院医院（伦敦，英国）住院的成人HIV感染患者中存在的病死率危险因素。我们回顾了494例连续的547次实验室确诊的PCP患者的病例记录。总死亡率为13.5%。1985年至1989年期间的死亡率为10.1%，1990年至1996年6月期间为16.9%，1996年7月至2006年期间为9.7%（P= 0.0142）。多变量分析确定了与死亡风险相关的因素，包括患者年龄的增加（校正比值比[AOR]，1.54; 95%置信区间[CI]，1.11-2.23;P = .011），随后发生PCP（AOR，2.27; 95% CI，1.14-4.52;），入院时血红蛋白水平低（AOR，0.70; 95% CI，0.60-0.83; Pp.入院时呼吸室空气氧分压低（AOR，0.70; 95%CI，0.60-0.81; P
Background. Pneumocystis jirovecii pneumonia (PCP) remains the leading cause of opportunistic infection among human immunodeficiency virus (HIV)-infected persons. Previous studies of PCP that identified case-fatality risk factors involved small numbers of patients, were performed over few years, and often focused on patients who were admitted to the intensive care unit.Objective. The objective of this study was to identify case-fatality risk factors present at or soon after hospitalization among adult HIV-infected patients admitted to University College London Hospitals (London, United Kingdom) from June 1985 through June 2006.Patients and Methods. We performed a review of case notes for 494 consecutive patients with 547 episodes of laboratory-confirmed PCP.Results. Overall mortality was 13.5%. Mortality was 10.1% for the period from 1985 through 1989, 16.9% for the period from 1990 through June 1996, and 9.7% for the period from July 1996 through 2006 (P=.0142). Multivariate analysis identified factors associated with risk of death, including increasing patient age (adjusted odds ratio [AOR], 1.54; 95% confidence interval [CI], 1.11-2.23;P = .011), subsequent episode of PCP (AOR, 2.27; 95% CI, 1.14-4.52;), low hemoglobin level at hospital admission (AOR, 0.70; 95% CI, 0.60-0.83; Pp. 019), low partial pressure of oxygen breathing room air at hospital admission (AOR, 0.70; 95% CI, 0.60-0.81; P