title: A prognostic scoring tool for identification of patients at high and low risk of death from HIV-associated Pneumocystis jirovecii pneumonia.
abstract: A prognostic scoring tool (PST) was created to aid prediction of outcome from HIV-associated Pneumocystis jirovecii pneumonia (PCP) using data obtained from 577 episodes of PCP among 540 patients presenting to a specialist HIV treatment centre in London, UK. It used risk factors identifiable at/soon after hospitalization, previously identified as being associated with mortality: repeat episode of PCP, patient's age, haemoglobin (Hb) and oxygen partial pressure (PaO(2)) on admission, presence of medical co-morbidity (Comorb) and of pulmonary Kaposi sarcoma (PKS). The derived PST was 25.5+(age in years/10) + 2 (if a repeat episode of PCP) + 3 (if Comorb present) + 4 (if PKS detected) - PaO(2) (kPa) - Hb (g/dL), and produced scores that ranged between 0 and 19. Patients were divided into five groups according to their prognostic score: 0-3.9 = group 1 (0% mortality), 4-7.9 = group 2 (3% mortality), 8-10.9 = group 3 (9% mortality), 11-14.9 = group 4 (29% mortality) and ≥ 15 = group 5 (52% mortality). This PST facilitates rapid identification of patients early in their hospitalization who have mild or severe HIV-associated PCP and who are at high and low risk of in-hospital death from PCP. The PST may aid assessment of severity of illness and in directing treatment strategies, but requires validation in patient cohorts from other health-care institutions.
authors.affiliation: Section of Infectious Diseases and Immunity, Imperial College London.
authors.forename: D
authors.initials: D
authors.lastname: Armstrong-James
authors.forename: A J
authors.initials: AJ
authors.lastname: Copas
authors.forename: P D
authors.initials: PD
authors.lastname: Walzer
authors.forename: S G
authors.initials: SG
authors.lastname: Edwards
authors.forename: R F
authors.initials: RF
authors.lastname: Miller
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000472:pathogenicity; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult