Journal of infection and public health · 2026
Association of PCR cycle threshold values in respiratory specimens with mechanical ventilation and mortality in HIV-negative pneumocystis jirovecii pneumonia.
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Lv Wenting, Sun Jibo, Jia Qingqing, Li Dajun, Liu Sitong, Zhang Shijie, Wang Dongguang, Wang Lian, He Xing, Tong Xiang, Fan Hong
Аннотация
BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal disease that can be lethal. The study assessed the prognostic value of Pneumocystis cycle threshold (Ct) values for mechanical ventilation(MV) and mortality in human immunodeficiency virus(HIV)-negative patients.
METHODS: A retrospective observational cohort study was conducted at a tertiary teaching hospital from April 2024 to March 2025. PJP Ct values were measured using real-time polymerase chain reaction(PCR) in respiratory specimens. Logistic regression and Cox proportional hazards regression were performed to find variables linked with MV and mortality. Exploratory nomograms were developed for MV and mortality.
RESULTS: Among the 184 HIV-negative PJP patients, 68 (37%) required MV and 69 (38%) died. Multivariable logistic regression showed that higher Ct(adjusted odds ratio[aOR]=0.755; 95% confidence interval[CI] [0.632, 0.890]; BH-adjusted p [q]=0.001) and platelet-to-white cell ratio(PWR, aOR=0.946; 95% CI [0.912, 0.976]; q = 0.001) were associated with lower odds of requiring MV. Higher lactic dehydrogenase(LDH) levels(aOR=1.003; 95% CI [1.001, 1.006]; q = 0.006) and Systemic Immune-Inflammation Index (SII, aOR=1.001; 95% CI [1.000-1.001]; q = 0.001) were linked with greater odds of requiring MV. Cox analysis showed higher Ct(adjusted hazard ratio[aHR]=0.842, 95% CI [0.745-0.952], q = 0.009) and albumin-to-globulin ratio(AGR,aHR=0.283, 95% CI [0.122-0.659], q = 0.007) were associated with lower PJP-cause mortality, whereas adjunctive corticosteroids(aHR=2.701, 95% CI [1.417-5.149], q = 0.007), older age(aHR=1.029, 95% CI [1.005-1.053], q = 0.023), higher LDH(aHR=1.001, 95% CI [1.001-1.002], q = 0.006), and higher Systemic Inflammatory Response Index(SIRI) (aHR=1.054, 95% CI [1.020-1.088], q = 0.024) were associated with higher PJP-cause mortality.
CONCLUSION: Lower Ct values were associated with higher mortality in patients with non-HIV PJP and may provide prognostic information. Higher age, adjunctive corticosteroid use, elevated SIRI, lower AGR and higher LDH were associated with higher PJP-cause mortality, whereas lower PWR, higher SII and higher LDH were associated with mechanical ventilation. These exploratory findings require further validation.
METHODS: A retrospective observational cohort study was conducted at a tertiary teaching hospital from April 2024 to March 2025. PJP Ct values were measured using real-time polymerase chain reaction(PCR) in respiratory specimens. Logistic regression and Cox proportional hazards regression were performed to find variables linked with MV and mortality. Exploratory nomograms were developed for MV and mortality.
RESULTS: Among the 184 HIV-negative PJP patients, 68 (37%) required MV and 69 (38%) died. Multivariable logistic regression showed that higher Ct(adjusted odds ratio[aOR]=0.755; 95% confidence interval[CI] [0.632, 0.890]; BH-adjusted p [q]=0.001) and platelet-to-white cell ratio(PWR, aOR=0.946; 95% CI [0.912, 0.976]; q = 0.001) were associated with lower odds of requiring MV. Higher lactic dehydrogenase(LDH) levels(aOR=1.003; 95% CI [1.001, 1.006]; q = 0.006) and Systemic Immune-Inflammation Index (SII, aOR=1.001; 95% CI [1.000-1.001]; q = 0.001) were linked with greater odds of requiring MV. Cox analysis showed higher Ct(adjusted hazard ratio[aHR]=0.842, 95% CI [0.745-0.952], q = 0.009) and albumin-to-globulin ratio(AGR,aHR=0.283, 95% CI [0.122-0.659], q = 0.007) were associated with lower PJP-cause mortality, whereas adjunctive corticosteroids(aHR=2.701, 95% CI [1.417-5.149], q = 0.007), older age(aHR=1.029, 95% CI [1.005-1.053], q = 0.023), higher LDH(aHR=1.001, 95% CI [1.001-1.002], q = 0.006), and higher Systemic Inflammatory Response Index(SIRI) (aHR=1.054, 95% CI [1.020-1.088], q = 0.024) were associated with higher PJP-cause mortality.
CONCLUSION: Lower Ct values were associated with higher mortality in patients with non-HIV PJP and may provide prognostic information. Higher age, adjunctive corticosteroid use, elevated SIRI, lower AGR and higher LDH were associated with higher PJP-cause mortality, whereas lower PWR, higher SII and higher LDH were associated with mechanical ventilation. These exploratory findings require further validation.