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Войти в исследования Frontiers in cellular and infection microbiology · 2026
Clinical course, treatment and outcome of severe pneumocystis pneumonia in patients with autoimmune or inflammatory diseases: a prospective study.
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Shi Yan, Wang Na, Rui Xi, Liu Wei, You Hui, Peng Jin-Min
Аннотация
BACKGROUND: The morbidity and mortality of Pneumocystis pneumonia (PCP) are rising among patients with autoimmune or inflammatory diseases (AID). Prospective studies focusing on severe PCP in this population remain scarce. A better understanding of the disease course and prognostic factors is urgently needed.
METHODS: A 5-year prospective single-center study in the ICU enrolled AID patients with severe PCP. Clinical, laboratory, radiological, therapeutic, and outcome data were collected prospectively. Multivariable regression was used to identify risk factors for initial treatment failure and 28-day ICU mortality.
RESULTS: Among 107 enrolled patients, the mean PaO2/FiO2 ratio was 167 mmHg, and 76.6% of patients required mechanical ventilation at ICU admission. Pulmonary coinfection was detected in 46 (43.0%) patients. Initial treatment failure occurred in 48.6% and was associated with underlying connective tissue disease-interstitial lung disease (OR 3.241, 95% CI 1.337-25.147, p = 0.004), coinfection (OR, 5.419; 95% CI, 1.565-38.759; p = 0.008), and severe hypoxemia on ICU admission (OR 6.873, 95% CI 1.746-31.048, p = 0.006). Follow-up pulmonary imaging revealed architectural distortions or worsening fibrosis in over 50% of patients. The 28-day ICU mortality was 57.0%; independently predicted by PaO2/FiO2 ratio < 100 mmHg at PCP onset (OR 8.119, 95% CI 1.543-32.871, p = 0.007), initial treatment failure (OR 10.591, 95% CI 1.926-45.768, p = 0.013), persistent CD4 + T-cell counts < 100 cells/μL (OR 4.137, 95% CI 1.219- 62.152, p = 0.021), fibrosis score > 260 during early follow-up (OR 5.354, 95% CI 1.513-19.756, p = 0.008), and new-onset shock during the ICU stay (OR 2.147, 95% CI 1.237-39.157, p = 0.018).
CONCLUSIONS: PCP is life-threatening in AID patients. Beyond baseline hypoxemia, early follow-up variables, particularly initial treatment failure and progressive pulmonary fibrosis, are critical prognostic indicators, warranting further research to drive understanding of their causes.
METHODS: A 5-year prospective single-center study in the ICU enrolled AID patients with severe PCP. Clinical, laboratory, radiological, therapeutic, and outcome data were collected prospectively. Multivariable regression was used to identify risk factors for initial treatment failure and 28-day ICU mortality.
RESULTS: Among 107 enrolled patients, the mean PaO2/FiO2 ratio was 167 mmHg, and 76.6% of patients required mechanical ventilation at ICU admission. Pulmonary coinfection was detected in 46 (43.0%) patients. Initial treatment failure occurred in 48.6% and was associated with underlying connective tissue disease-interstitial lung disease (OR 3.241, 95% CI 1.337-25.147, p = 0.004), coinfection (OR, 5.419; 95% CI, 1.565-38.759; p = 0.008), and severe hypoxemia on ICU admission (OR 6.873, 95% CI 1.746-31.048, p = 0.006). Follow-up pulmonary imaging revealed architectural distortions or worsening fibrosis in over 50% of patients. The 28-day ICU mortality was 57.0%; independently predicted by PaO2/FiO2 ratio < 100 mmHg at PCP onset (OR 8.119, 95% CI 1.543-32.871, p = 0.007), initial treatment failure (OR 10.591, 95% CI 1.926-45.768, p = 0.013), persistent CD4 + T-cell counts < 100 cells/μL (OR 4.137, 95% CI 1.219- 62.152, p = 0.021), fibrosis score > 260 during early follow-up (OR 5.354, 95% CI 1.513-19.756, p = 0.008), and new-onset shock during the ICU stay (OR 2.147, 95% CI 1.237-39.157, p = 0.018).
CONCLUSIONS: PCP is life-threatening in AID patients. Beyond baseline hypoxemia, early follow-up variables, particularly initial treatment failure and progressive pulmonary fibrosis, are critical prognostic indicators, warranting further research to drive understanding of their causes.