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  • Poster presentation
  • Open Access

Outcome and prognostic factors in patients with HIV-negative pneumocystis pneumonia requiring mechanical ventilation

  • 1
Critical Care201014 (Suppl 1) :P90

https://doi.org/10.1186/cc8322

  • Published:

Keywords

  • Mechanical Ventilation
  • Respiratory Failure
  • Immunosuppressive Agent
  • Absolute Neutrophil Count
  • Care Teaching

Introduction

Pneumocystis pneumonia (PCP) in HIV-negative patients frequently presents as fulminant respiratory failure and is associated with a high mortality rate when the patient requires mechanical ventilation. The aims of this study were to evaluate the outcome and prognostic factors in the patients with HIV-negative PCP requiring mechanical ventilation (MV).

Methods

We retrospectively reviewed the medical records and collected the HIV-negative patients who were microbiologically confirmed as PCP and required MV in ICU over a 10-year period in a tertiary care teaching hospital.

Results

A total of 51 patients were identified. Mean age was 55.4 ± 15.0 years. Mean APACHE II score at ICU admission was 25.7 ± 5.8. The 28-day mortality and in-hospital mortality were 45.8% and 66.7%, respectively. Between survivors and nonsurvivors, there were no significant differences in baseline characteristics, APACHE II score, PaO2/FiO2 ratio, and absolute neutrophil counts on ICU admission day. Also the mortality was not different in relation to the presence of barotrauma, application of non-invasive ventilation, timing of susceptible antibiotic administration, changing or not to salvage regimens, presence of cytomegalovirus co-infection and even the microbiologic persistency in follow-up specimens. Based on the types and intensity of previous immunosuppressive therapy, we classified patients into three subgroups: patients receiving low-dose steroid maintenance ± other immunosuppressive agents (LS), which represent previously stable organ transplants; another group consisting of patients receiving recent intensive chemotherapy (CTx); and the other group refers to patients receiving high dose (defined as >2 weeks at least 1 mg/kg dose) steroid therapy ± other immunosuppressive agents (HS). Significant differences of outcome were observed among the three different groups (28-day mortality: LS = 22.2%, CTx = 29.4%, HS = 71.4%, P = 0.01; 60-day mortality: LS = 33.3%, CTx = 64.7%, HS = 81.0%, P = 0.04).

Conclusions

Our data showed that the mortality of fulminant HIV-negative PCP requiring MV was significantly different according to the types and intensity of previous immunosuppressive treatment despite similar clinical features on ICU admission.

Authors’ Affiliations

(1)
Asan Medical Center, Seoul, Republic of Korea

Copyright

© BioMed Central Ltd. 2010

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