Pneumocystis carinii pneumonia requiring intensive care management: survival and prognostic study in 110 patients with human immunodeficiency virus.
OBJECTIVE
To perform a descriptive study of patients with acute respiratory failure secondary to acquired immunodeficiency syndrome-related Pneumocystis carinii pneumonia and to identify variables that are predictive of death within 3 months.


METHODS
Case series study.


METHODS
Infectious disease intensive care unit (ICU) in a university hospital.


METHODS
Detailed clinical, laboratory, and ventilatory data were collected prospectively within 48 hrs of admission and during the ICU stay in 110 consecutive human immunodeficiency virus-infected patients requiring ICU management with or without mechanical ventilation for P. carinii pneumonia-related acute respiratory failure.


RESULTS
Continuous positive airway pressure was used initially in 66 (60%) patients. Among the 34 patients (31%) who required mechanical ventilation, including 12 at admission and 22 after failure of continuous positive airway pressure, 76% died. The 3-month mortality rate after ICU admission was estimated at 34.6% (95% confidence interval [CI], 25%-44%). The 1-yr survival rate was estimated at 47% (95% CI, 36%-58%). With successive multiple logistic regression models analyzing the relative prognostic importance of baseline clinical and laboratory tests variables, ventilation variables, and events in the ICU, only delayed mechanical ventilation after 3 days (odd ratio [OR], 6.7; 95% CI, 1.9-23.9), duration of mechanical ventilation of > or = 5 days (OR, 2.8; 95% CI, 1.1-6.9), nosocomial infection (OR, 5.2; 95% CI, 2.1-12.9), and pneumothorax (OR, 5; 95% CI, 1.7-14.7) were predictive of death within 3 months of ICU admission. Among patients with delayed mechanical ventilation on day 3 or later and with a pneumothorax associated or not associated with a nosocomial infection, the predicted probability of 3-month death was close to 100%.


CONCLUSIONS
Our data suggest that the most significant predictive factors of death were identifiable during the course of P. carinii pneumonia-related acute respiratory failure rather than at admission and can help in bedside decisions to withdraw intensive care support in such patients.
Service de Réanimation des Maladies Infectieuses, Groupe Hospitalier Bichat-Claude Bernard, Paris, France.
J P
JP
Bédos
J L
JL
Dumoulin
B
B
Gachot
B
B
Veber
M
M
Wolff
B
B
Régnier
S
S
Chevret
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000401:mortality / Q000628:therapy*; D018806:APACHE; D000208:Acute Disease; D000328:Adult; D003422:Critical Care / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011175:Positive-Pressure Respiration; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate