Article
作者: Mojoli, Francesco ; Dessajan, Julien ; Del Puente, Filippo ; Vaconsin, Louis-Maxime ; Lahmer, Tobias ; Mora, Sara ; Gasch, Oriol ; Ceresini, Mariaelena ; Muccio, Marco ; de la Villa Martínez, Sofía ; De Pascale, Gennaro ; Koehler, Philipp ; Seidel, Danila ; Pelosi, Paolo ; Tascini, Carlo ; Di Pilato, Vincenzo ; Razazi, Keyvan ; Mikulska, Malgorzata ; Garnaud, Cécile ; Marchese, Anna ; Bonnal, Christine ; Russelli, Giovanna ; Prina, Elena ; Di Meco, Gabriele ; Brunetti, Iole ; Asperges, Erika ; Bassetti, Matteo ; Garcia Borrega, Jorge ; Cerchiaro, Matteo ; Haschka, Stefanie ; Hermans, Greet ; Alastruey-Izquierdo, Ana ; Mekontso-Dessap, Armand ; Lagrou, Katrien ; Zaccarelli, Mario ; Valerio, Maricela ; Signori, Alessio ; Gallego, Miguel ; Dibos, Miriam ; Cesarano, Melania ; Marín Arriaza, Mercedes ; Díaz, Emili ; Wauters, Joost ; Meersseman, Philippe ; Magnasco, Laura ; Ball, Lorenzo ; Galerneau, Louis-Marie ; Hänsel, Luise ; Nordlander, Anna ; Rasch, Sebastian ; Blennow, Ola ; Dartevel, Anais ; Lombardi, Gianmarco ; Martin-Loeches, Ignacio ; Calvet, Laure ; Giacobbe, Daniele Roberto ; Vargas, Joel ; Icardi, Giancarlo ; de Montmollin, Etienne ; Giacomini, Mauro ; Bruzzone, Bianca ; Fallon, Melissa ; Cornely, Oliver A. ; Robba, Chiara ; Wilmer, Alexander ; Marelli, Cristina ; Battaglini, Denise ; Muñoz, Patricia ; González Saez, Adolfo ; Poissy, Julien ; Mularoni, Alessandra ; Dettori, Silvia ; Lewis White, Philip ; Vola, Ambra ; Capra Marzani, Federico ; Gennenzi, Veronica ; Berti, Enora ; Choudaly, Sofia ; Vena, Antonio ; Timsit, Jean-Francois ; de Prost, Nicolas ; Carteaux, Guillaume ; Casabella, Antonio
BACKGROUND:Pneumocystis jirovecii pneumonia (PJP) is a life-threatening disease. In the intensive care unit (ICU), PJP is most frequently observed among patients with several conditions not related to the human immunodeficiency virus (HIV) infection.
METHODS:The primary objective of the present post-hoc analysis of a multicenter, multinational, retrospective study was to assess factors impacting prognosis in ICU patients with PJP through univariable and multivariable analyses.
RESULTS:A total of 107 patients were included; 28 had proven PJP (26.2%), and 79 had presumptive PJP (73.8%). The overall 30-day mortality was 52.7% (95% confidence interval [CI] 42.1-62.2). In the multivariable analysis, metastatic solid tumor (hazard ratio [HR] 3.49; 95% CI 1.71-7.13, p < 0.001) and chronic liver disease (HR 2.44; 95% CI 1.03-5.80, p = 0.044) showed an independent association with 30-day mortality. The direction of effect remained consistent when center was added to the multivariable model as random effect.
CONCLUSION:PJP mortality remains high in ICU patients. Conditions other than HIV infection are emerging not only as non-classical risk factors for PJP development, but also as important mortality predictors. A better understanding of the reasons underlying this evolving landscape could be crucial to improve PJP management and survival.