title: Pneumocystis pneumonia in HIV-infected and immunocompromised non-HIV infected patients: a retrospective study of two centers in China.
abstract: BACKGROUND
  Pneumocystis pneumonia (PCP) is an emerging infectious disease in immunocompromised hosts. However, the clinical characteristics of these patients are poorly understood in mainland China.
  
  
  METHODS
  We performed a retrospective study of PCP from 2008 to 2012. Information was collected regarding clinical manifestations, hospitalization, and outcome. A prognostic analysis was performed using a Cox regression model.
  
  
  RESULTS
  151 cases of PCP were included; 46 non-HIV and 105 HIV cases. All-cause mortality (15.2% vs. 12.4%, p = 0.64) and the results of time-to-event analysis (log-rank test, p = 0.62) were similar between non-HIV and HIV infected cases, respectively. From 2008 to 2012, time from admission to initial treatment in non-HIV infected PCP patients showed declining trend [median (range) 20 (9-44) vs. 12 (4-24) vs. 9 (2-23) vs. 7 (2-22) vs. 7 (1-14) days]. A similar trend was observed for all-cause mortality (33.3% vs. 20.0% vs.14.3% vs. 14.3% vs. 6.7%). Patients with four or more of the following clinical manifestations (cough, dyspnea, fever, chest pain, and weight loss) [adjusted HR (AHR) 29.06, 95% CI 2.13-396.36, P = 0.01] and admission to intensive care unit (ICU) [AHR 22.55, 95% CI 1.36-375.06, P = 0.03] were independently associated with all-cause mortality in non-HIV infected PCP patients. Variables associated with mortality in HIV infected PCP patients were admission to ICU (AHR 72.26, 95% CI 11.76-443.87, P<0.001) and albumin ≤ 30 g/L (AHR 9.93 95% CI 1.69-58.30, P = 0.01).
  
  
  CONCLUSIONS
  Upon admission comprehensive clinical assessment including assessment of four or more clinical manifestations (cough, dyspnea, fever, chest pain, and weight loss) in non-HIV infected PCP patients and albumin ≤ 30 g/L in HIV infected patients might improve prognosis.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, Republic of China.
authors.forename: Fei
authors.initials: F
authors.lastname: Guo
authors.affiliation: Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, Republic of China.
authors.forename: Shuang-Li
authors.initials: SL
authors.lastname: Yang
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, Republic of China.
authors.forename: Huan
authors.initials: H
authors.lastname: Xia
authors.affiliation: Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, Republic of China.
authors.forename: Xing-Wang
authors.initials: XW
authors.lastname: Li
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, Republic of China.
authors.forename: Zhao-Hui
authors.initials: ZH
authors.lastname: Tong
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000328:Adult; D002681:China / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome