Pneumocystis jirovecii pneumonia (PCP) PCR-negative conversion predicts prognosis of HIV-negative patients with PCP and acute respiratory failure

Ji Soo Choi, Sang Hoon Lee, Ah Young Leem, Joo Han Song, Song Yee Kim, Kyung Soo Chung, Ji Ye Jung, youngae kang, Young Sam Kim, Joon Chang, Moo Suk Park

Research output: Contribution to journalArticle

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Abstract

Background Pneumocystis jirovecii pneumonia (PCP) is often fatal in human immunodeficiency (HIV)negative patients and typically presents with respiratory insufficiency. Predicting treatment failure is challenging. This study aimed to identify prognostic factors and examine PCP polymerase chain reaction (PCR)-negative conversion in non-HIV PCP patients with respiratory failure. Method We retrospectively enrolled 81 non-HIV patients diagnosed with and treated for PCP with respiratory failure in the intensive care unit at a tertiary hospital over a 3-year period. PCP was diagnosed via nested PCR-mediated detection of Pneumocystis jirovecii in induced sputum samples, endotracheal aspirates, and bronchoalveolar lavage fluids. PCP PCR was performed weekly to check for negative conversion. Results The overall survival rate was 35.8%. Seventy-four patients (91.3%) required mechanical ventilation, and 6 (7.4%) required high-flow nasal oxygen treatment. The PCP PCR-negative conversion rate was 70.5% (survivors, 97%; non-survivors, 63.5%); the median time to conversion was 10 (7.0-14.0) days. On univariate analysis, the APACHE II score (p < 0.001), renal failure requiring renal replacement therapy (p = 0.04), PCP PCR-negative conversion (p = 0.003), and the PaO 2 /FiO 2 ratio (first 24 hours) (p < 0.001) significantly correlated with mortality. On multivariate analysis, PCP PCR-negative conversion (hazard ratio, 0.433; 95% confidence interval, 0.203-0.928; p = 0.031) and the PaO 2 /FiO 2 ratio (first 24 hours) (hazard ratio, 0.988; 95% confidence interval, 0.983-0.993; p < 0.001) independently predicted prognosis. Conclusions Determination of PCP PCR-negative conversion and PaO 2 /FiO 2 ratios may help physicians predict treatment failure and mortality in non-HIV PCP patients with respiratory failure.

Original languageEnglish
Article numbere0206231
JournalPloS one
Volume13
Issue number10
DOIs
Publication statusPublished - 2018 Oct 1

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Pneumocystis
Pneumocystis carinii
Pneumocystis Pneumonia
Polymerase chain reaction
Respiratory Insufficiency
pneumonia
prognosis
polymerase chain reaction
HIV
Polymerase Chain Reaction
Hazards
Intensive care units
Treatment Failure
confidence interval
Confidence Intervals
APACHE
Renal Replacement Therapy
Oxygen
Mortality
immunosuppression

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Choi, Ji Soo ; Lee, Sang Hoon ; Leem, Ah Young ; Song, Joo Han ; Kim, Song Yee ; Chung, Kyung Soo ; Jung, Ji Ye ; kang, youngae ; Kim, Young Sam ; Chang, Joon ; Park, Moo Suk. / Pneumocystis jirovecii pneumonia (PCP) PCR-negative conversion predicts prognosis of HIV-negative patients with PCP and acute respiratory failure. In: PloS one. 2018 ; Vol. 13, No. 10.
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title = "Pneumocystis jirovecii pneumonia (PCP) PCR-negative conversion predicts prognosis of HIV-negative patients with PCP and acute respiratory failure",
abstract = "Background Pneumocystis jirovecii pneumonia (PCP) is often fatal in human immunodeficiency (HIV)negative patients and typically presents with respiratory insufficiency. Predicting treatment failure is challenging. This study aimed to identify prognostic factors and examine PCP polymerase chain reaction (PCR)-negative conversion in non-HIV PCP patients with respiratory failure. Method We retrospectively enrolled 81 non-HIV patients diagnosed with and treated for PCP with respiratory failure in the intensive care unit at a tertiary hospital over a 3-year period. PCP was diagnosed via nested PCR-mediated detection of Pneumocystis jirovecii in induced sputum samples, endotracheal aspirates, and bronchoalveolar lavage fluids. PCP PCR was performed weekly to check for negative conversion. Results The overall survival rate was 35.8{\%}. Seventy-four patients (91.3{\%}) required mechanical ventilation, and 6 (7.4{\%}) required high-flow nasal oxygen treatment. The PCP PCR-negative conversion rate was 70.5{\%} (survivors, 97{\%}; non-survivors, 63.5{\%}); the median time to conversion was 10 (7.0-14.0) days. On univariate analysis, the APACHE II score (p < 0.001), renal failure requiring renal replacement therapy (p = 0.04), PCP PCR-negative conversion (p = 0.003), and the PaO 2 /FiO 2 ratio (first 24 hours) (p < 0.001) significantly correlated with mortality. On multivariate analysis, PCP PCR-negative conversion (hazard ratio, 0.433; 95{\%} confidence interval, 0.203-0.928; p = 0.031) and the PaO 2 /FiO 2 ratio (first 24 hours) (hazard ratio, 0.988; 95{\%} confidence interval, 0.983-0.993; p < 0.001) independently predicted prognosis. Conclusions Determination of PCP PCR-negative conversion and PaO 2 /FiO 2 ratios may help physicians predict treatment failure and mortality in non-HIV PCP patients with respiratory failure.",
author = "Choi, {Ji Soo} and Lee, {Sang Hoon} and Leem, {Ah Young} and Song, {Joo Han} and Kim, {Song Yee} and Chung, {Kyung Soo} and Jung, {Ji Ye} and youngae kang and Kim, {Young Sam} and Joon Chang and Park, {Moo Suk}",
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Pneumocystis jirovecii pneumonia (PCP) PCR-negative conversion predicts prognosis of HIV-negative patients with PCP and acute respiratory failure. / Choi, Ji Soo; Lee, Sang Hoon; Leem, Ah Young; Song, Joo Han; Kim, Song Yee; Chung, Kyung Soo; Jung, Ji Ye; kang, youngae; Kim, Young Sam; Chang, Joon; Park, Moo Suk.

In: PloS one, Vol. 13, No. 10, e0206231, 01.10.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pneumocystis jirovecii pneumonia (PCP) PCR-negative conversion predicts prognosis of HIV-negative patients with PCP and acute respiratory failure

AU - Choi, Ji Soo

AU - Lee, Sang Hoon

AU - Leem, Ah Young

AU - Song, Joo Han

AU - Kim, Song Yee

AU - Chung, Kyung Soo

AU - Jung, Ji Ye

AU - kang, youngae

AU - Kim, Young Sam

AU - Chang, Joon

AU - Park, Moo Suk

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background Pneumocystis jirovecii pneumonia (PCP) is often fatal in human immunodeficiency (HIV)negative patients and typically presents with respiratory insufficiency. Predicting treatment failure is challenging. This study aimed to identify prognostic factors and examine PCP polymerase chain reaction (PCR)-negative conversion in non-HIV PCP patients with respiratory failure. Method We retrospectively enrolled 81 non-HIV patients diagnosed with and treated for PCP with respiratory failure in the intensive care unit at a tertiary hospital over a 3-year period. PCP was diagnosed via nested PCR-mediated detection of Pneumocystis jirovecii in induced sputum samples, endotracheal aspirates, and bronchoalveolar lavage fluids. PCP PCR was performed weekly to check for negative conversion. Results The overall survival rate was 35.8%. Seventy-four patients (91.3%) required mechanical ventilation, and 6 (7.4%) required high-flow nasal oxygen treatment. The PCP PCR-negative conversion rate was 70.5% (survivors, 97%; non-survivors, 63.5%); the median time to conversion was 10 (7.0-14.0) days. On univariate analysis, the APACHE II score (p < 0.001), renal failure requiring renal replacement therapy (p = 0.04), PCP PCR-negative conversion (p = 0.003), and the PaO 2 /FiO 2 ratio (first 24 hours) (p < 0.001) significantly correlated with mortality. On multivariate analysis, PCP PCR-negative conversion (hazard ratio, 0.433; 95% confidence interval, 0.203-0.928; p = 0.031) and the PaO 2 /FiO 2 ratio (first 24 hours) (hazard ratio, 0.988; 95% confidence interval, 0.983-0.993; p < 0.001) independently predicted prognosis. Conclusions Determination of PCP PCR-negative conversion and PaO 2 /FiO 2 ratios may help physicians predict treatment failure and mortality in non-HIV PCP patients with respiratory failure.

AB - Background Pneumocystis jirovecii pneumonia (PCP) is often fatal in human immunodeficiency (HIV)negative patients and typically presents with respiratory insufficiency. Predicting treatment failure is challenging. This study aimed to identify prognostic factors and examine PCP polymerase chain reaction (PCR)-negative conversion in non-HIV PCP patients with respiratory failure. Method We retrospectively enrolled 81 non-HIV patients diagnosed with and treated for PCP with respiratory failure in the intensive care unit at a tertiary hospital over a 3-year period. PCP was diagnosed via nested PCR-mediated detection of Pneumocystis jirovecii in induced sputum samples, endotracheal aspirates, and bronchoalveolar lavage fluids. PCP PCR was performed weekly to check for negative conversion. Results The overall survival rate was 35.8%. Seventy-four patients (91.3%) required mechanical ventilation, and 6 (7.4%) required high-flow nasal oxygen treatment. The PCP PCR-negative conversion rate was 70.5% (survivors, 97%; non-survivors, 63.5%); the median time to conversion was 10 (7.0-14.0) days. On univariate analysis, the APACHE II score (p < 0.001), renal failure requiring renal replacement therapy (p = 0.04), PCP PCR-negative conversion (p = 0.003), and the PaO 2 /FiO 2 ratio (first 24 hours) (p < 0.001) significantly correlated with mortality. On multivariate analysis, PCP PCR-negative conversion (hazard ratio, 0.433; 95% confidence interval, 0.203-0.928; p = 0.031) and the PaO 2 /FiO 2 ratio (first 24 hours) (hazard ratio, 0.988; 95% confidence interval, 0.983-0.993; p < 0.001) independently predicted prognosis. Conclusions Determination of PCP PCR-negative conversion and PaO 2 /FiO 2 ratios may help physicians predict treatment failure and mortality in non-HIV PCP patients with respiratory failure.

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U2 - 10.1371/journal.pone.0206231

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