About: Outcome and prognostic factors of Pneumocystis jirovecii pneumonia in immunocompromised adults: a prospective observational study

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About: Outcome and prognostic factors of Pneumocystis jirovecii pneumonia in immunocompromised adults: a prospective observational study Goto Sponge NotDistinct Permalink

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
has title	Outcome and prognostic factors of Pneumocystis jirovecii pneumonia in immunocompromised adults: a prospective observational study
Creator	Canet, Emmanuel Asseray, Nathalie Boutoille, David Deschanvres, Colin Gaborit, Benjamin Garret, Charlotte Khatchatourian, Lydie Lavergne, Rose-Anne Lecomte, Raphael Leturnier, Paul Marest, Delphine Morio, Florent Raffi, François Reignier, Jean Sagan, Christine Tessoulin, Benoit Vourch, Michael
Source	PMC
abstract	BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) remains a severe disease associated with high rates of invasive mechanical ventilation (MV) and mortality. The objectives of this study were to assess early risk factors for severe PJP and 90-day mortality, including the broncho-alveolar lavage fluid cytology profiles at diagnosis. METHODS: We prospectively enrolled all patients meeting pre-defined diagnostic criteria for PJP admitted at Nantes university hospital, France, from January 2012 to January 2017. Diagnostic criteria for PJP were typical clinical features with microbiological confirmation of P. jirovecii cysts by direct examination or a positive specific quantitative real-time polymerase chain reaction (PCR) assay. Severe PJP was defined as hypoxemic acute respiratory failure requiring high-flow nasal oxygen with at least 50% FiO(2), non-invasive ventilation, or MV. RESULTS: Of 2446 respiratory samples investigated during the study period, 514 from 430 patients were positive for P. jirovecii. Of these 430 patients, 107 met criteria for PJP and were included in the study, 53 (49.5%) patients had severe PJP, including 30 who required MV. All patients were immunocompromised with haematological malignancy ranking first (n = 37, 35%), followed by solid organ transplantation (n = 27, 25%), HIV-infection (n = 21, 20%), systemic diseases (n = 13, 12%), solid tumors (n = 12, 11%) and primary immunodeficiency (n = 6, 8%). By multivariate analysis, factors independently associated with severity were older age (OR, 3.36; 95% CI 1.4–8.5; p < 0.05), a P. jirovecii microscopy-positive result from bronchoalveolar lavage (BAL) (OR, 1.3; 95% CI 1.54–9.3; p < 0.05); and absence of a BAL fluid alveolitis profile (OR, 3.2; 95% CI 1.27–8.8; p < 0.04). The 90-day mortality rate was 27%, increasing to 50% in the severe PJP group. Factors independently associated with 90-day mortality were worse SOFA score on day 1 (OR, 1.05; 95% CI 1.02–1.09; p < 0.001) whereas alveolitis at BAL was protective (OR, 0.79; 95% CI 0.65–0.96; p < 0.05). In the subgroup of HIV-negative patients, similar findings were obtained, then viral co-infection were independently associated with higher 90-day mortality (OR, 1.25; 95% CI 1.02–1.55; p < 0.05). CONCLUSIONS: Older age and P. jirovecii oocysts at microscopic examination of BAL were independently associated with severe PJP. Both initial PJP severity as evaluated by the SOFA score and viral co-infection predicted 90-day mortality. Alveolitis at BAL examination was associated with less severe PJP. The pathophysiological mechanism underlying this observation deserves further investigation.
has issue date	2019-11-27(xsd:dateTime)
bibo:doi	10.1186/s13613-019-0604-x
bibo:pmid	31776705
has license	cc-by
sha1sum (hex)	4a2c92cb3474488b76d0f262e76e9b027a72e48e
schema:url	https://doi.org/10.1186/s13613-019-0604-x
resource representing a document's title	Outcome and prognostic factors of Pneumocystis jirovecii pneumonia in immunocompromised adults: a prospective observational study
has PubMed Central identifier	PMC6881486
has PubMed identifier	31776705
schema:publication	Ann Intensive Care
resource representing a document's body	covid:4a2c92cb3474488b76d0f262e76e9b027a72e48e#body_text
is schema:about of	named entity 'Pneumocystis jirovecii' named entity 'observational study' named entity 'BACKGROUND' named entity 'disease' named entity 'Pneumocystis jirovecii' named entity 'diagnosis' named entity 'invasive mechanical ventilation' named entity 'observational study' named entity 'Open Access' named entity 'pneumonia' named entity 'prognostic' named entity 'coinfection' named entity 'Fisher's exact test' named entity 'adjuvant' named entity 'clinical findings' named entity 'co-infection' named entity 'prognostic significance' named entity 'anti-microbial' named entity 'PJP' named entity 'primary immunodeficiency' named entity 'PJP' named entity 'Lymphocytes' named entity 'intensive care unit' named entity 'alveolitis' named entity 'antiretroviral therapy' named entity 'immunosuppression' named entity '95% CI' named entity '21.3' named entity 'retrospective study' named entity 'PJP' named entity 'hematology' named entity 'solid organ transplantation' named entity 'murine models' named entity 'co-infection' named entity 'PJP' named entity 'ICU' named entity 'cytology' named entity 'follow-up' named entity 'HIV' named entity 'HIV' named entity 'glucocorticoid' named entity '95% CI' named entity 'SOFA score' named entity 'fraction of inspired oxygen' named entity 'PJP' named entity 'PJP' named entity 'prospective cohort' named entity 'immunocompromised patients' named entity 'Glucocorticoid' named entity 'lymphopenia' named entity 'alveolitis' named entity 'Bacterial infection' named entity 'HIV' named entity 'serum' named entity 'Haematological malignancies' named entity 'PJP' named entity 'PJP' named entity 'fungal infection' named entity 'neutrophils' named entity 'CRP' named entity 'systemic diseases' named entity 'acute respiratory distress syndrome' named entity 'intensive care' named entity 'SOFA score' named entity 'PJP'

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