Predicting in-hospital outcome in HIV-associated Pneumocystis carinii pneumonia.
Pneumocystis carinii pneumonia (PCP) in HIV-infected patients remains a life-threatening complication in the course of HIV infection. Despite effective treatment, mortality may still be as high as 10%. The identification of risk factors associated with a lethal outcome might be helpful as a guide to therapy for patients at risk and in the evaluation of new drugs with anti-pneumocystic activity. In a retrospective study 58 first episodes of HIV-associated PCP without prophylaxis were analyzed. Variables associated univariately with higher mortality were identified. A prognostic rule was established in a multivariate approach using canonical discriminant analysis. Cut-off values for parameters included were determined in order to allow a clinically applicable estimate of the individual risk. Variables associated with early mortality were hemoglobin, hematocrit, platelet count, albumin, total protein, gamma-globulins, and AaDO2. LDH values, percentage of neutrophils in the BAL, as well as the cellular immunologic state as indicated by CD4-cell count were not significantly associated with the outcome. The discriminant function yielded the best classification results with the inclusion of hemoglobin, albumin, and gamma-globulins (overall accuracy 86%). Two or more of the following parameters were associated with a 14-fold increased risk of in-hospital mortality: hemoglobin less than 10 g/dl, albumin less than 3 g/dl, and gamma-globulins less than 1.2 g/dl. This prognostic rule was 80% sensitive and 94% specific with a negative predictive value of 94%, yielding an overall accuracy of 91%. Patients with HIV-associated PCP with a positive prognostic rule have a 14-fold increased risk for in-hospital lethal outcome. This discriminant rule may be helpful in identifying patients at risk.
Bauer
T
T
Berufsgenossenschaftliche Kliniken Bergmannsheil, Abt. f. Pneumologie u. Allergologie, Bochum, Germany.
Ewig
S
S
Hasper
E
E
Rockstroh
J K
JK
Lüderitz
B
B
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D000328:Adult; D001424:Bacterial Infections / Q000150:complications; D018893:Bronchoalveolar Lavage; D002177:Candidiasis / Q000150:complications; D005260:Female; D006761:Hospitals; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors