M W Fei1, E J Kim, C A Sant, L G Jarlsberg, J L Davis, A Swartzman, L Huang. 1. Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California 94110, USA. matt.w.fei@gmail.com
Abstract
BACKGROUND: Although the use of antiretroviral therapy has led to dramatic declines in AIDS-associated mortality, Pneumocystis pneumonia (PCP) remains a leading cause of death in HIV-infected patients. OBJECTIVES: To measure mortality, identify predictors of mortality at time of illness presentation and derive a PCP mortality prediction rule that stratifies patients by risk for mortality. METHODS: An observational cohort study with case note review of all HIV-infected persons with a laboratory diagnosis of PCP at San Francisco General Hospital from 1997 to 2006. RESULTS: 451 patients were diagnosed with PCP on 524 occasions. In-hospital mortality was 10.3%. Multivariate analysis identified five significant predictors of mortality: age (adjusted odds ratio (AOR) per 10-year increase, 1.69; 95% CI 1.08 to 2.65; p = 0.02); recent injection drug use (AOR 2.86; 95% CI 1.28 to 6.42; p = 0.01); total bilirubin >0.6 mg/dl (AOR 2.59; 95% CI 1.19 to 5.62; p = 0.02); serum albumin <3 g/dl (AOR 3.63; 95% CI 1.72-7.66; p = 0.001); and alveolar-arterial oxygen gradient >or=50 mm Hg (AOR 3.02; 95% CI 1.41 to 6.47; p = 0.004). Using these five predictors, a six-point PCP mortality prediction rule was derived that stratifies patients according to increasing risk of mortality: score 0-1, 4%; score 2-3, 12%; score 4-5, 48%. CONCLUSIONS: The PCP mortality prediction rule stratifies patients by mortality risk at the time of illness presentation and should be validated as a clinical tool.
BACKGROUND: Although the use of antiretroviral therapy has led to dramatic declines in AIDS-associated mortality, Pneumocystis pneumonia (PCP) remains a leading cause of death in HIV-infectedpatients. OBJECTIVES: To measure mortality, identify predictors of mortality at time of illness presentation and derive a PCP mortality prediction rule that stratifies patients by risk for mortality. METHODS: An observational cohort study with case note review of all HIV-infectedpersons with a laboratory diagnosis of PCP at San Francisco General Hospital from 1997 to 2006. RESULTS: 451 patients were diagnosed with PCP on 524 occasions. In-hospital mortality was 10.3%. Multivariate analysis identified five significant predictors of mortality: age (adjusted odds ratio (AOR) per 10-year increase, 1.69; 95% CI 1.08 to 2.65; p = 0.02); recent injection drug use (AOR 2.86; 95% CI 1.28 to 6.42; p = 0.01); total bilirubin >0.6 mg/dl (AOR 2.59; 95% CI 1.19 to 5.62; p = 0.02); serum albumin <3 g/dl (AOR 3.63; 95% CI 1.72-7.66; p = 0.001); and alveolar-arterial oxygen gradient >or=50 mm Hg (AOR 3.02; 95% CI 1.41 to 6.47; p = 0.004). Using these five predictors, a six-point PCP mortality prediction rule was derived that stratifies patients according to increasing risk of mortality: score 0-1, 4%; score 2-3, 12%; score 4-5, 48%. CONCLUSIONS: The PCP mortality prediction rule stratifies patients by mortality risk at the time of illness presentation and should be validated as a clinical tool.
Authors: J E Kaplan; D Hanson; M S Dworkin; T Frederick; J Bertolli; M L Lindegren; S Holmberg; J L Jones Journal: Clin Infect Dis Date: 2000-04 Impact factor: 9.079
Authors: A M Arozullah; P R Yarnold; R A Weinstein; N Nwadiaro; T B McIlraith; J S Chmiel; A M Sipler; C Chan; M B Goetz; D N Schwartz; C L Bennett Journal: Am J Respir Crit Care Med Date: 2000-04 Impact factor: 21.405
Authors: Constance R Uphold; Maria Deloria-Knoll; Frank J Palella; Jorge P Parada; Joan S Chmiel; Laura Phan; Charles L Bennett Journal: Chest Date: 2004-02 Impact factor: 9.410
Authors: R Zhai; C C Sheu; L Su; M N Gong; P Tejera; F Chen; Z Wang; M P Convery; B T Thompson; D C Christiani Journal: Thorax Date: 2009-05-28 Impact factor: 9.139
Authors: Colleen F Kelley; William Checkley; David M Mannino; Carlos Franco-Paredes; Carlos Del Rio; Fernando Holguin Journal: Chest Date: 2009-03-02 Impact factor: 9.410
Authors: Laurence Huang; Adithya Cattamanchi; J Lucian Davis; Saskia den Boon; Joseph Kovacs; Steven Meshnick; Robert F Miller; Peter D Walzer; William Worodria; Henry Masur Journal: Proc Am Thorac Soc Date: 2011-06
Authors: Christian M Parobek; Linda Y Jiang; Jaymin C Patel; Miriam J Alvarez-Martínez; Jose M Miro; William Worodria; Alfred Andama; Serena Fong; Laurence Huang; Steven R Meshnick; Steve M Taylor; Jonathan J Juliano Journal: J Clin Microbiol Date: 2014-02-12 Impact factor: 5.948