Prognostic markers of short-term mortality in AIDS-associated Pneumocystis carinii pneumonia.
BACKGROUND
Since 1990, corticosteroids have been recommended as adjunctive therapy for patients with AIDS-associated Pneumocystis carinii pneumonia (PCP) and respiratory failure. We hypothesized that the natural course of AIDS-associated PCP has changed in the era of adjunctive corticosteroid therapy.


OBJECTIVE
To study variables obtained on hospital admission for possible prognostic value of short-term (3-month) outcome of PCP.


METHODS
Prospective observational study of 176 consecutive HIV-1-infected individuals with PCP between 1990 and 1999.


METHODS
Cox proportional-hazards regression models.


RESULTS
Univariate analysis showed that age, one or more prior episodes of PCP, use of antimicrobial therapy other than trimethoprim-sulfamethoxazole (TMP-SMZ), use of PCP prophylaxis at diagnosis, and culture of cytomegalovirus (CMV) in BAL predicted progression to death within 3 months. After adjustment, age (relative risk [RR], 4.1; 95% confidence interval [CI], 1.8 to 9.3), initial antimicrobial therapy other than TMP-SMZ (RR, 3.1; 95% CI, 1.2 to 8.5), use of PCP prophylaxis (RR, 5.6; 95% CI, 2.2 to 14.4), and culture of CMV in BAL fluid (RR, 2.7; 95% CI, 1.3 to 5.6) remained independent predictors of a poor outcome. In contrast, neither PO(2) nor serum lactate dehydrogenase, which in earlier studies were identified as prognostic markers, were predictors of mortality.


CONCLUSIONS
Age, initial anti-PCP therapy, use of PCP prophylaxis, and BAL CMV status may be useful predictors of outcome of PCP in patients treated in the era of adjunctive corticosteroid therapy.
Department of Infectious Diseases, University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark. tbenfield@inet.uni2.dk
T L
TL
Benfield
J
J
Helweg-Larsen
D
D
Bang
J
J
Junge
J D
JD
Lundgren
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality* / Q000517:prevention & control; D000328:Adult; D000367:Age Factors; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D016022:Case-Control Studies; D003587:Cytomegalovirus / Q000302:isolation & purification; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000401:mortality* / Q000517:prevention & control; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors