Prospective evaluation of a prognostic score for Pneumocystis carinii pneumonia in HIV-infected patients.
Serum lactate dehydrogenase levels, alveolar-arterial oxygen gradient, and percentage of neutrophils in bronchoalveolar lavage correlate most strongly with early mortality in Pneumocystis carinii pneumonia (PCP) in HIV-infected patients. However, the individual outcome can not be predicted by these parameters due to a considerable overlap between survivors and nonsurvivors. We prospectively investigated a PCP severity score, which has been developed earlier based on a retrospective analysis. Seven of 94 consecutively examined HIV-infected patients died within 14 days after diagnosis of PCP. A PCP severity score greater than 7 had a positive predictive value for early fatal outcome of 66.7 percent (6/9) and a negative predictive value of 98.8 percent (84/85). The overall diagnostic accuracy was 95.7 percent (90/94). The positive predictive value for early fatal outcome of a P(A-a)O2 > 35 mm Hg was 24 percent (6/25); the negative predictive value was 98.6 percent (68/69). However, the overall diagnostic accuracy was only 78.7 percent (74/94). The PCP severity score is a valuable tool for clinical decision making, for the early identification of patients with a prognostic unfavorable course, and for the comparison of patient populations in future studies of HIV-associated PCP.
Speich
R
R
Department of Internal Medicine, University Hospital of Zurich, Switzerland.
Opravil
M
M
Weber
R
R
Hess
T
T
Luethy
R
R
Russi
E W
EW
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000401:mortality* / Q000473:pathology; D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000473:pathology; D002452:Cell Count; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D009504:Neutrophils / Q000473:pathology; D010100:Oxygen / Q000097:blood; D011020:Pneumonia, Pneumocystis / Q000097:blood / Q000401:mortality* / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index
D007770:L-Lactate Dehydrogenase; D010100:Oxygen