Abstract
Background The increasing incidence of life-threatening Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients is a global concern. Yet, no reports have examined the prognostic significance of pre-existing interstitial lung disease (ILD) in non-HIV PCP.
Methods We retrospectively reviewed the medical records of non-HIV PCP patients with (ILD group) or without (non-ILD group) pre-existing ILD. The clinical features and outcomes of the ILD group were compared with those of the non-ILD group. Cox regression models were constructed to identify prognostic factors.
Results 74 patients were enrolled in this study. The 90-day mortality was significantly higher in the ILD group than in the non-ILD group (62.5% versus 19.0%, p<0.001). In the ILD group, patients with a higher percentage of bronchoalveolar lavage fluid neutrophils had worse outcomes compared to those having a lower percentage (p=0.026). Multivariate analyses revealed that pre-existing ILD (p=0.002) and low levels of serum albumin (p=0.009) were independent risk factors for 90-day mortality. Serum levels of β-d-glucan were significantly reduced after treatment of PCP in both groups, whereas levels of Krebs von den Lungen-6 (KL-6) significantly increased in the ILD group. In the ILD group, the 90-day mortality of patients with increasing KL-6 levels after treatment was significantly higher than those with decreasing levels (78.9% versus 0%, p=0.019).
Conclusion In non-HIV PCP patients, pre-existing ILD is associated with a poorer prognosis. Prophylaxis for PCP is needed in patients with pre-existing ILD under immunosuppression.
Abstract
Pre-existing interstitial lung disease (ILD) is an independent prognostic risk factor for non- HIV Pneumocystis pneumonia (PCP). Prophylaxis for PCP is needed in patients with pre-existing ILD under immunosuppression. http://bit.ly/37BGZuK
Footnotes
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Conflict of interest: S. Hamada has nothing to disclose.
Conflict of interest: H. Ichiyasu has nothing to disclose.
Conflict of interest: M. Inaba has nothing to disclose.
Conflict of interest: H. Takahashi has nothing to disclose.
Conflict of interest: T. Sadamatsu has nothing to disclose.
Conflict of interest: K. Akaike has nothing to disclose.
Conflict of interest: A. Masunaga has nothing to disclose.
Conflict of interest: Y. Tashiro has nothing to disclose.
Conflict of interest: N. Hirata has nothing to disclose.
Conflict of interest: T. Yoshinaga has nothing to disclose.
Conflict of interest: T. Sakagami has nothing to disclose.
- Received November 6, 2019.
- Accepted February 11, 2020.
- Copyright ©ERS 2020
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