Acute respiratory failure due to Pneumocystis pneumonia: outcome and prognostic factors

Objectives: To examine the outcome and prognostic factors of in-hospital mortality in patients with acute respiratory failure (ARF) caused by Pneumocystis pneumonia (PCP) admitted to a medical intensive care unit. Methods: A retrospective review was conducted of all patients with ARF from PCP in Ramathibodi Hospital between 2000 and 2006. Patient characteristics, clinical presentation, and laboratory, radiological and microbiological findings, as welt as therapy and clinical course were included in the analysis of prognostic factors of death. Results: A total of 14 HIV-infected and 30 otherwise immunosuppressed patients were identified. The overall mortality rate was 63.6%. Logistic regression analysis demonstrated that APACHE II score on day 1 and level of PEEP used on day 3 of respiratory failure were associated with higher hospital mortality. In a comparison between the HIV group and the non-HIV group, the early mortality rate was significantly higher in the HIV group, but late hospital mortality was not different between the two groups. Using a univariate logistic regression model, four parameters were found to be significantly associated with death in the HIV group: sex, APACHE II score on day 1, CMV co-infection, and level of PEEP on day 3 of ARE In the non-HIV group, corticosteroid use prior to diagnosis of PCP and level of PEEP on day 3 of ARF were found to be the significant parameters. Conclusion: The mortality rate in patients with ARF caused by PCP was high. Various variable factors were related to a poor prognosis. For improved survival, multimodality treatments are needed to reduce these risk factors. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.