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.
Benfield
T L
TL
Department of Infectious Diseases, University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark. tbenfield@inet.uni2.dk
Helweg-Larsen
J
J
Bang
D
D
Junge
J
J
Lundgren
J D
JD
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