Acute respiratory failure due to Pneumocystis pneumonia in patients without human immunodeficiency virus infection - Outcome and associated features
Acute respiratory failure due to Pneumocystis pneumonia in patients without human immunodeficiency virus infection - Outcome and associated features
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DOI：
10.1378/chest.128.2.573
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发表时间：
2005-08-01
期刊：
影响因子：
9.6
通讯作者：
Aksamit, TR
中科院分区：
文献类型：
--
作者：
Festic, E;Gajic, O;Aksamit, TR
目的：研究1995年至2002年期间入住医学ICU的非HIV相关肺孢子虫肺炎（PCP）患者急性呼吸衰竭（ARF）的结局和相关因素。设计：回顾性分析病历和APACHE（急性生理学和慢性健康评估）III数据库。设置：学术三级医疗中心。结果：我们确定了30例非HIV相关PCP和ARF患者。住院、6个月和1年死亡率分别为67%、77%和80%。中位年龄为63.5岁。第1天的中位APACHE III评分为65.5。中位ICU和住院时间分别为13天和21天。所有7名气胸患者均死亡。除1例患者外，所有患者的乳酸脱氢酶水平均升高（中位数为563 U/L）。28例经支气管肺泡灌洗液检查确诊，2例经支气管镜活检确诊。所有患者均接受免疫抑制治疗（8例接受皮质类固醇治疗，7例接受化疗，其余患者接受两种治疗）。中位免疫抑制泼尼松等效剂量为40 mg（中位治疗时间为4.5个月）。没有一名患者接受过PCP预防。除一名患者外，所有患者均需要插管和有创正压通气（PPV）。住院死亡率与第1天APACHE III评分高（p = 0.05）、插管延迟（p = 0.03）、PPV长度（p = 0.003）和气胸发生（p = 0.033）相关。逻辑回归分析表明，在调整疾病严重程度后，插管延迟与住院死亡率的相关性仍然存在（p = 0.03）。结论：在非HIV相关PCP继发的ARF患者中，预后不良的因素包括高APACHE III评分、插管延迟、PPV持续时间较长以及发生气胸。本系列中没有患者在发生肺炎之前接受PCP预防。
Objective: To examine outcome and associated factors of acute respiratory failure (ARF) in non-HIV-related Pneumocystis pneumonia (PCP) in patients admitted to a medical ICU between 1995 and 2002.Design: A retrospective review of medical records and an APACHE (acute physiology and chronic health evaluation) III database.Setting: Academic tertiary medical center.Results: We identified 30 patients with non-HIV-related PCP and ARF. In-hospital, 6-month, and 1-year mortality rates were 67%, 77%, and 80%, respectively. Median age was 63.5 years. Median APACHE III score on day 1 was 65.5. Median ICU and hospital lengths of stay were 13 days and 21 days, respectively. All seven patients having a pneumothorax died. All but one patient had an elevated lactate dehydrogenase level (median, 563 U/L). The diagnosis was made using BAL in 28 patients and by transbronchial biopsy in the remaining 2 patients. All patients were immunosuppressed (eight were receiving corticosteroids, seven were receiving chemotherapy, and the remainder received both). Median immunosuppressive prednisone-equivalent dose was 40 mg (median length of treatment, 4.5 months). Not a single patient received PCP prophylaxis. All but one patient required intubation and invasive positive pressure ventilation (PPV). Hospital mortality was associated with high APACHE III scores on day I (p = 0.05), intubation delay (p = 0.03), length of PPV (p = 0.003), and development of pneumothorax (p = 0.033). Logistic regression analysis demonstrated that association of intubation delay with hospital mortality persisted after adjusting for severity of illness (p = 0.03).Conclusions: Among patients with ARF secondary to non-HIV-related PCP, poor prognostic factors include high APACHE III scores, intubation delay, longer duration of PPV, and development of pneumothorax. None of the patients in this series received PCP prophylaxis prior to the development of pneumonia.