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

Gaborit, Benjamin Jean; Tessoulin, Benoit; Lavergne, Rose-Anne; Morio, Florent; Sagan, Christine; Canet, Emmanuel; Lecomte, Raphael; Leturnier, Paul; Deschanvres, Colin; Khatchatourian, Lydie; Asseray, Nathalie; Garret, Charlotte; Vourch, Michael; Marest, Delphine; Raffi, François; Boutoille, David; Reignier, Jean

doi:10.1186/s13613-019-0604-x

Annals of Intensive Care

Table 2 Comparison of patients with severe and non-severe Pneumocystis jirovecii pneumonia

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

	Severe PJP (n = 53)	Non-severe PJP (n = 54)	p value
Age, years, mean ± SD	59.23 ± 18	51.97 ± 18	0.019
Males, n (%)	34 (64)	31 (57)	0.554
BMI, kg/m², mean ± SD	23.55 ± 8	22.45 ± 8	0.254
Serum albumin, g/L, mean ± SD	25.08 ± 12	28.85 ± 12	< 0.001
Chronic underlying disease, n (%)
Chronic pulmonary disease	17 (32.08)	16 (29.63)	0.836
Chronic kidney disease	10 (18.87)	14 (25.93)	0.423
Chronic heart failure	6 (11.32)	3 (5.56)	0.320
ICU admission, n (%)	48 (90.57)	3 (5.56)	< 0.0001
PaO₂/FiO₂ on admission, mean ± SD	111.38 ± 54	269.66 ± 112	< 0.0001
SAPS2, mean ± SD	38.37±	28.19±	< 0.0001
SOFA score on day 1, mean ± SD	5 ± 3.1	1 ± 1.5	< 0.0001
Cause of immunodeficiency, n (%)^a
Haematological malignancy	21 (39.6)	16 (29.6)	0.314
Solid organ transplant	13 (24.53)	14 (25.93)	1
HIV infection	6 (11.1)	15 (28.3)	0.050
Systemic disease	9 (16.98)	4 (7.41)	0.150
Solid malignancy	6 (11.32)	6 (11.11)	1
Primary immunodeficiency	3 (5.66)	5 (9.26)	0.477
Ongoing immunosuppressive therapy, n (%)	45 (84.91)	38 (70.37)	0.104
Ongoing glucocorticoid therapy, n (%)	30 (56.6)	21 (38.89)	0.083
Prednisolone-equivalent dosage, mg/day, mean ± SD	20.2 ± 30.26	14.69 ± 30.42	0.102
PJP prophylaxis, n (%)	9 (17)	12 (22)	0.495
Time from symptom onset to admission, days, mean ± SD	10.85 ± 20.38	15.2 ± 20.53	0.327
Time from symptom onset to initiation of effective therapy, days, mean ± SD	13.89 ± 21.9	18.04 ± 17.1	0.28
Laboratory findings, mean ± SD
White blood cells/mm³	17.76 ± 36	7.29 ± 8.15	< 0.001
Neutrophils/mm³	10.07 ± 18	4.77 ± 4.34	0.001
Lymphocytes/mm³	2262.48 ± 8766	1809.4 ± 7017	0.766
CRP, mg/L	148.75 ± 105	74.04 ± 70.65	< 0.001
LDH, µKat/L	9.79 ± 7	5.93 ± 3.9	0.012
Bronchoalveolar lavage (BAL), time from symptom onset, days, mean ± SD	2.23 ± 4.69	3.27 ± 3.72	0.229
PJ visible in smears, n (%)	31 (58.49)	18 (33.33)	0.011
Neutrophils, %, mean ± SD	30.09	14.46	< 0.001
Macrophages, %, mean ± SD	43.76	49.7	0.349
Lymphocytes, %, mean ± SD	31.22	34.24	0.383
Alveolitis profile, n (%)	9 (16.98)	22 (40.74)	0.007
Co-infection at PJP diagnosis
Viral infection, n (%)	26 (49.06)	19 (35.19)	0.173
Bacterial infection, n (%)	9 (16.98)	11 (20.37)	0.805
Invasive fungal infection, n (%)	2 (3.77)	3 (5.56)	1
Respiratory support
Mechanical ventilation, n (%)	30 (56.60)	0	< 0.0001
Non-invasive ventilation, n (%)	2 (3.77)	0	1
90-day mortality, n (%)	24 (45)	5 (9)	< 0.0001

BMI, body mass index; ICU, intensive care unit; ARDS, acute respiratory distress syndrome; SAPS2, simplified acute physiology score version 2; SOFA score, sequential organ failure assessment score; HIV, human immunodeficiency virus; PJP, Pneumocystis jirovecii pneumonia; CPR, C-reactive protein; LDH, lactate dehydrogenase; PJ, Pneumocystis jirovecii
^aThe total exceeds 100% because some patients had more than one cause of immunodeficiency. Significant values are shown in italicface

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