title: Mortality predictors of Pneumocystis jirovecii pneumonia in human immunodeficiency virus-infected patients at presentation: Experience in a tertiary care hospital of northern Taiwan.
abstract: BACKGROUND
  Pneumocystis jirovecii pneumonia (PJP) remains the leading cause of opportunistic infections and deaths among human immunodeficiency virus (HIV)-infected patients. We would like to identify the predictors of mortality of these patients at initial presentation, and assist clinicians to aware the patients in risk of mortality earlier.
  
  
  METHODS
  From 1997 to 2009, adults with HIV infection and a discharge diagnosis of PJP at Mackay Memorial Hospital were included in this retrospective study. Patients' demographic data and laboratory data were analyzed by reviewing the medical records.
  
  
  RESULTS
  Eighty-five patients were included in this study. The overall mortality rate was 37.7%. Univariate analysis revealed several host factors significantly related to mortality, including age, systolic blood pressure, diastolic blood pressure, partial pressure of oxygen in arterial blood (PaO(2)), percentage of lymphocyte, percentage of CD4 lymphocyte, CD4 counts, serum total protein, serum albumin, and blood urea nitrogen. Multivariate analysis identified three independent predictors associated with mortality, i.e. systolic blood pressure ≤110 mmHg [adjusted odds ratio (AOR) 3.88; 95% confidence interval (CI) 1.17-12.83; p = 0.03], PaO(2) at room air ≤60 mmHg (AOR 4.97; 95% CI 1.34-18.23; p = 0.01), and lymphocytes ≤10% (AOR 8.19; 95% CI 1.48-45.36; p = 0.02). With these predictors, we can stratify patients into three groups with increasing risks for mortality, ≤one predictor (mortality rate 14%), any two predictors (47%), and three predictors (75%).
  
  
  CONCLUSIONS
  HIV-infected patients with PJP can be clinically stratified by three prognostic variables identified by multivariate analysis. Early recognition of patients in higher risk can assist clinicians to prevent rapid deterioration and seek for better outcomes.
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Hsiao-Wei
authors.initials: HW
authors.lastname: Wang
authors.forename: Cheng-Chih
authors.initials: CC
authors.lastname: Lin
authors.forename: Chen-Feng
authors.initials: CF
authors.lastname: Kuo
authors.forename: Chang-Pan
authors.initials: CP
authors.lastname: Liu
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Lee
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000382:microbiology* / Q000401:mortality*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001774:Blood Chemical Analysis; D018791:CD4 Lymphocyte Count; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000097:blood / Q000401:mortality* / Q000821:virology*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D055986:Vital Signs