title: Adjunctive steroid in HIV-negative patients with severe Pneumocystis pneumonia.
abstract: BACKGROUND
  High-dose steroid therapy has been proven effective in AIDS-related Pneumocystis pneumonia (PCP) but not in non-AIDS-related cases. We evaluated the effects on survival of steroids in HIV-negative patients with PCP.
  
  
  METHODS
  Retrospective study patients admitted to the ICU with hypoxemic PCP. We compared patients receiving HDS (≥1 mg/Kg/day prednisone equivalent), low-dose steroids (LDS group, <1 mg/Kg/day prednisone equivalent), and no steroids (NS group). Variables independently associated with ICU mortality were identified.
  
  
  RESULTS
  139 HIV-negative patients with PCP were included. Median age was 48 [40-60] years. The main underlying conditions were hematological malignancies (n=55, 39.6%), cancer (n=11, 7.9%), and solid organ transplantation (n=73, 52.2%). ICU mortality was 26% (36 deaths). The HDS group had 72 (51.8%) patients, the LDS group 35 (25%) patients, and the NS group 32 (23%) patients. Independent predictors of ICU mortality were SAPS II at ICU admission (odds ratio [OR], 1.04/point; [95%CI], 1.01-1.08, P=0.01), non-hematological disease (OR, 4.06; [95%CI], 1.19-13.09, P=0.03), vasopressor use (OR, 20.31; 95%CI, 6.45-63.9, P<0.001), and HDS (OR, 9.33; 95%CI, 1.97-44.3, P=0.02). HDS was not associated with the rate of ICU-acquired infections.
  
  
  CONCLUSIONS
  HDS were associated with increased mortality in HIV-negative patients with PCP via a mechanism independent from an increased risk of infection.
authors: Medical Intensive Care Unit, Saint Louis Teaching Hospital, 1 Avenue Claude Vellefaux, Paris 75010, France. virginie.lemiale@sls.aphp.fr.
authors: Virginie
authors: V
authors: Lemiale
authors: Alexandre
authors: A
authors: Debrumetz
authors: Alexandra
authors: A
authors: Delannoy
authors: Corinne
authors: C
authors: Alberti
authors: Elie
authors: E
authors: Azoulay
mesh_terms: D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D011241:Prednisone / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D013256:Steroids; D011241:Prednisone
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