Plasma IL-6 level predict the risk of in-hospital mortality in HIV-associated pneumocystis pneumonia.

BACKGROUND

The study aimed to determine plasma immune-inflammatory biomarkers that may predict in-hospital mortality in human immunodeficiency virus (HIV)-infected individuals diagnosed with pneumocystis jirovecii pneumonia (PCP).

METHODS

This study prospectively included 125 antiretroviral therapy (ART)-naïve, HIV-infected patients with PCP. Biomarkers involving clinical variables and 8 pre-selected plasma inflammatory cytokines (IL-2, IL-4, IL-6, IL-10, IL-12, IL-17, TNF-α, and IFN-γ) were evaluated at time of admission. Multivariate logistic regression analysis was used to identify factors substantially associated with in-hospital mortality. The ROC curve was used to determine the predictive value of biomarkers for in-hospital mortality.

RESULTS

Our results show a hospital mortality rate of 12.8% (16/125). When compared to surviving AIDS PCP patients, non-survivors had substantially higher levels of C-reactive protein, IL-6, aspartate aminotransferase, and lactate dehydrogenase (LDH) and lower levels of albumin (ALB), PO2, and CD4 count. We found a significant association between increased IL-6 levels and hospital mortality using multivariable logistic regression analysis (adjusted odds ratio per 20 pg/mL increase, 1.127; 95% CI, 1.047-1.230; p = 0.004). The plasma IL-6 levels had the largest area under the curve (AUC) (0.883; 95%CI, 0.812-0.953), compared to CD4+ T cell (AUC, 0.789; 95%CI, 0.697-0.881), ALB (AUC, 0.776; 95%CI, 0.661-0.892), and LDH (AUC, 0.703; 95%CI, 0.573-0.832).

CONCLUSIONS

Elevated plasma IL-6 levels at admission are significantly associated with an increased risk of in-hospital mortality in HIV-infected patients with PCP.

CLINICAL TRIAL NUMBER: Not applicable.