Predicting mortality from HIV-associated Pneumocystis pneumonia at illness presentation: an observational cohort study.
BACKGROUND
Although the use of antiretroviral therapy has led to dramatic declines in AIDS-associated mortality, Pneumocystis pneumonia (PCP) remains a leading cause of death in HIV-infected patients.


OBJECTIVE
To measure mortality, identify predictors of mortality at time of illness presentation and derive a PCP mortality prediction rule that stratifies patients by risk for mortality.


METHODS
An observational cohort study with case note review of all HIV-infected persons with a laboratory diagnosis of PCP at San Francisco General Hospital from 1997 to 2006.


RESULTS
451 patients were diagnosed with PCP on 524 occasions. In-hospital mortality was 10.3%. Multivariate analysis identified five significant predictors of mortality: age (adjusted odds ratio (AOR) per 10-year increase, 1.69; 95% CI 1.08 to 2.65; p = 0.02); recent injection drug use (AOR 2.86; 95% CI 1.28 to 6.42; p = 0.01); total bilirubin >0.6 mg/dl (AOR 2.59; 95% CI 1.19 to 5.62; p = 0.02); serum albumin <3 g/dl (AOR 3.63; 95% CI 1.72-7.66; p = 0.001); and alveolar-arterial oxygen gradient >or=50 mm Hg (AOR 3.02; 95% CI 1.41 to 6.47; p = 0.004). Using these five predictors, a six-point PCP mortality prediction rule was derived that stratifies patients according to increasing risk of mortality: score 0-1, 4%; score 2-3, 12%; score 4-5, 48%.


CONCLUSIONS
The PCP mortality prediction rule stratifies patients by mortality risk at the time of illness presentation and should be validated as a clinical tool.
Fei
M W
MW
Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California 94110, USA. matt.w.fei@gmail.com
Kim
E J
EJ
Sant
C A
CA
Jarlsberg
L G
LG
Davis
J L
JL
Swartzman
A
A
Huang
L
L
D017088:AIDS-Related Opportunistic Infections / Q000378:metabolism / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000367:Age Factors; D001663:Bilirubin / Q000032:analysis; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000378:metabolism / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D011659:Pulmonary Gas Exchange; D012495:San Francisco / Q000453:epidemiology; D012709:Serum Albumin / Q000032:analysis; D015819:Substance Abuse, Intravenous / Q000150:complications; D016896:Treatment Outcome
D012709:Serum Albumin; D001663:Bilirubin