Table 1 Studies characteristics included in this meta-analysis
Series no. | References author, year of publish | Study design | Country | Total no. of patients | Causes of immunosuppression | Method of PCP diagnosis | Definition of adjunctive corticosteroids use |
|---|---|---|---|---|---|---|---|
1 | Pareja, 1998 | Retrospective single center | USA | 30 | Organ transplantation = 13; longterm immunosuppressive therapy = 9; Chemotherapy for malignancy = 8 | Morphological | ≥ 60 mg prednisone daily equivalent |
2 | Delclaux, 1999 | Retrospective two center | France | 31 | Hematologic malignancy = 24; vasculitis = 3; solid tumor = 2; other = 2 | Morphological (demonstration of typical organism in specimens BALF) | 1. De novo therapy (for patients who did not receive previous CS): oral prednisone > 1 mg/kg/day or iv methylprednisolone 240 mg for 3 days- > 120 mg for 3 days- > 60 mg for 3 days or longer 2. Rescue therapy(for patients already receiving CS): corticosteroid increased at least 300% of the baseline |
3 | Zahar, 2002 | Retrospective two center | France | 39 | Malignancy: hematological malignancies = 28 Solid tumor = 7; nonmalignant hematological diseases = 4 | Positive results for cytological tests or direct fluorescent antibody staining for PCP in sputum or BALF | 240 mg/day for 3 days, with the dosage then tapered during the next 10 days, until no therapy was given |
4 | Pagano, 2002 | Retrospective multicenter | Italy | 55 | Malignant hematological diseases: on-Hodgkin’s lymphoma = 18 Acute lymphoblastic leukemia = 10 Acute myeloid leukemia = 8; chronic myeloid leukemia = 5 | Microbiologically (positive visualization, mAbs, or PCR of PC in sputum or BALF) and/or histologically documented | Methylprednisolone (50–80 mg/day) |
5 | Roblot, 2003 | Retrospective multicenter | France | 60 | Hematologic malignancies: non-Hodgkin’s malignant lymphoma = 18 Chronic lymphocytic leukemia = 13; acute leukemia = 10 Multiple myeloma = 5; Waldenstro¨m’s diseases = 4; chronic myeloid leukemia = 4 Myelodysplasia = 3; Hodgkin’s diseases = 2; thrombopenia = 1 | Microbiological evidence of PC in BALF (silver and eosin þ methylene blue stainings and/or immunostaining using monoclonal antibodies) | Dose and duration of adjunctive corticosteroids use was not detailed reported |
6 | Bollee, 2007 | Retrospective single center | France | 56 | Cancer: hematologic malignancies = 44; solid tumors = 12 | PCP with Giemsa staining and/or immunofluorescence with human monoclonal anti-Pneumocystis cyst antibodies in BALF or sputum | 1 mg/kg of prednisone (or equivalent) per day or in a 30-mg increase in the daily prednisone dosage |
7 | Aoki, 2009 | Retrospective single center | Japan | 25 | Collagen vascular diseases | Elevated concentration of plasma 1,3-d-glucan, and positive PCR test for PCP in sputum | Dose and duration of adjunctive corticosteroids use was not detailed reported |
8 | Matsumura, 2011 | Retrospective multicenter | Japan | 82 | Inflammatory diseases = 50; solid malignancies = 17 Hematological malignancies = 12; transplantations = 6 | Diagnosed with PCP by PCR | Dose and duration of adjunctive corticosteroids use was not detailed reported |
9 | Moon, 2011 | Retrospective single center | Korea | 88 | Solid-organ transplant = 26; hematologic malignancy = 26 Non-hematologic malignancy = 12; interstitial lung disease = 9 Connective tissue disease = 7; others = 8 | Diagnosis was based on a positive result in the direct immunofluorescence assay for PCP | At least 40 mg prednisone twice daily for 5 days |
10 | Kim, 2014 | Retrospective multicenter | Korea | 173 | Hematologic malignancy = 81; solid tumors = 38 Organ transplantations = 17; others = 37 | Positive direct fluorescent antibody (DFA) or PCR results from a sputum or BAL fluid sample | Dose and duration of adjunctive corticosteroids use was not detailed reported |
11 | Kofteridis, 2014 | Retrospective single center | Greece | 62 | Malignant hematological disease = 31; solid tumor = 16 Chronic inflammatory disease = 15 | Positive results of direct fluorescent antibody staining for PCP in samples of induced sputum or BALF | Dose and duration of adjunctive corticosteroids use was not detailed reported |
12 | Weng, 2016 | Retrospective multicenter | China | 82 | CTD = 65; organ transplant = 3; hematologic malignancy = 3; solid tumor = 4 | PCR or methenamine silver stain of samples from BALF, aspirate or sputum | Dose and duration of adjunctive corticosteroids use was not detailed reported |
13 | Kotani, 2017 | retrospective single center | Japan | 20 | Rheumatoid arthritis or CTD = 9; renal transplant = 7; other = 4 | By fluorescent antibody staining using induced sputum or BALF | Methylprednisolone was dependent on the prior dosage of steroids and any underlying diseases |
14 | Wieruszewski, 2018 | Retrospective single center | USA | 332 | Hematologic malignancy = 162; bone marrow transplantation = 26 Inflammatory of connective tissue disease = 100 Solid organ tumor = 61; solid organ transplantation = 20 | A Positive single-copy PCP PCR or smear from a respiratory specimen | Corticosteroids within 48 h |
15 | Inoue, 2019 | Retrospective multicenter | Japan | 1299 | After transplantation = 34; solid tumor = 245 Malignancy of lymphoid tissue = 160; rheumatoid arthritis = 257 Connective tissue disease = 80 | Based on records | Adjunctive corticosteroids were defined < 250 mg/day corticosteroids or high dose pulse steroid therapy which refers to the administration of 250 mg prednisone equivalent a day for one or a few days (usually less than 5 days) |
16 | Liu, 2019 | Retrospective single center | China | 84 | Hematologic malignancy = 29; autoimmune diseases = 21 Solid cancers = 17; solid organ transplantation = 7 | Quantitative real-time PCR | Adjunctive steroids were high dose (≥ 1 mg/kg/day) |