Acute respiratory failure due to pneumocystis pneumonia in patients without human immunodeficiency virus infection: Outcome and associated features

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Abstract

Objective: To examine outcome and associated factors of acute respiratory failure (ARF) in non-HIV-related Pneumocystis pneumonia (PCP) in patients admitted to a medical ICU between 1995 and 2002. Design: A retrospective review of medical records and an APACHE (acute physiology and chronic health evaluation) III database. Setting: Academic tertiary medical center. Results: We identified 30 patients with non-HIV-related PCP and ARF. In-hospital, 6-month, and 1-year mortality rates were 67%, 77%, and 80%, respectively. Median age was 63.5 years. Median APACHE III score on day 1 was 65.5. Median ICU and hospital lengths of stay were 13 days and 21 days, respectively. All seven patients having a pneumothorax died. All but one patient had an elevated lactate dehydrogenase level (median, 563 U/L). The diagnosis was made using BAL in 28 patients and by transbronchial biopsy in the remaining 2 patients. All patients were immunosuppressed (eight were receiving corticosteroids, seven were receiving chemotherapy, and the remainder received both). Median immunosuppressive prednisone-equivalent dose was 40 mg (median length of treatment, 4.5 months). Not a single patient received PCP prophylaxis. All but one patient required intubation and invasive positive pressure ventilation (PPV). Hospital mortality was associated with high APACHE III scores on day 1 (p = 0.05), intubation delay (p = 0.03), length of PPV (p = 0.003), and development of pneumothorax (p = 0.033). Logistic regression analysis demonstrated that association of intubation delay with hospital mortality persisted after adjusting for severity of illness (p = 0.03). Conclusions: Among patients with ARF secondary to non-HIV-related PCP, poor prognostic factors include high APACHE III scores, intubation delay, longer duration of PPV, and development of pneumothorax. None of the patients in this series received PCP prophylaxis prior to the development of pneumonia.

Original languageEnglish (US)
Pages (from-to)573-579
Number of pages7
JournalChest
Volume128
Issue number2
DOIs
StatePublished - Aug 2005

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Pneumocystis Pneumonia
Virus Diseases
Respiratory Insufficiency
HIV
APACHE
Intubation
Positive-Pressure Respiration
Pneumothorax
Hospital Mortality
Length of Stay
Dimercaprol
Immunosuppressive Agents
Prednisone
L-Lactate Dehydrogenase
Medical Records
Pneumonia
Adrenal Cortex Hormones
Logistic Models
Regression Analysis
Databases

Keywords

  • Acute respiratory failure
  • ICU
  • Pneumocystis pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

@article{ead127a6c8d544609bfcafc5b61a4cf0,
title = "Acute respiratory failure due to pneumocystis pneumonia in patients without human immunodeficiency virus infection: Outcome and associated features",
abstract = "Objective: To examine outcome and associated factors of acute respiratory failure (ARF) in non-HIV-related Pneumocystis pneumonia (PCP) in patients admitted to a medical ICU between 1995 and 2002. Design: A retrospective review of medical records and an APACHE (acute physiology and chronic health evaluation) III database. Setting: Academic tertiary medical center. Results: We identified 30 patients with non-HIV-related PCP and ARF. In-hospital, 6-month, and 1-year mortality rates were 67{\%}, 77{\%}, and 80{\%}, respectively. Median age was 63.5 years. Median APACHE III score on day 1 was 65.5. Median ICU and hospital lengths of stay were 13 days and 21 days, respectively. All seven patients having a pneumothorax died. All but one patient had an elevated lactate dehydrogenase level (median, 563 U/L). The diagnosis was made using BAL in 28 patients and by transbronchial biopsy in the remaining 2 patients. All patients were immunosuppressed (eight were receiving corticosteroids, seven were receiving chemotherapy, and the remainder received both). Median immunosuppressive prednisone-equivalent dose was 40 mg (median length of treatment, 4.5 months). Not a single patient received PCP prophylaxis. All but one patient required intubation and invasive positive pressure ventilation (PPV). Hospital mortality was associated with high APACHE III scores on day 1 (p = 0.05), intubation delay (p = 0.03), length of PPV (p = 0.003), and development of pneumothorax (p = 0.033). Logistic regression analysis demonstrated that association of intubation delay with hospital mortality persisted after adjusting for severity of illness (p = 0.03). Conclusions: Among patients with ARF secondary to non-HIV-related PCP, poor prognostic factors include high APACHE III scores, intubation delay, longer duration of PPV, and development of pneumothorax. None of the patients in this series received PCP prophylaxis prior to the development of pneumonia.",
keywords = "Acute respiratory failure, ICU, Pneumocystis pneumonia",
author = "Emir Festic and Ognjen Gajic and Limper, {Andrew Harold} and Timothy Aksamit",
year = "2005",
month = "8",
doi = "10.1378/chest.128.2.573",
language = "English (US)",
volume = "128",
pages = "573--579",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "2",

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TY - JOUR

T1 - Acute respiratory failure due to pneumocystis pneumonia in patients without human immunodeficiency virus infection

T2 - Outcome and associated features

AU - Festic, Emir

AU - Gajic, Ognjen

AU - Limper, Andrew Harold

AU - Aksamit, Timothy

PY - 2005/8

Y1 - 2005/8

N2 - Objective: To examine outcome and associated factors of acute respiratory failure (ARF) in non-HIV-related Pneumocystis pneumonia (PCP) in patients admitted to a medical ICU between 1995 and 2002. Design: A retrospective review of medical records and an APACHE (acute physiology and chronic health evaluation) III database. Setting: Academic tertiary medical center. Results: We identified 30 patients with non-HIV-related PCP and ARF. In-hospital, 6-month, and 1-year mortality rates were 67%, 77%, and 80%, respectively. Median age was 63.5 years. Median APACHE III score on day 1 was 65.5. Median ICU and hospital lengths of stay were 13 days and 21 days, respectively. All seven patients having a pneumothorax died. All but one patient had an elevated lactate dehydrogenase level (median, 563 U/L). The diagnosis was made using BAL in 28 patients and by transbronchial biopsy in the remaining 2 patients. All patients were immunosuppressed (eight were receiving corticosteroids, seven were receiving chemotherapy, and the remainder received both). Median immunosuppressive prednisone-equivalent dose was 40 mg (median length of treatment, 4.5 months). Not a single patient received PCP prophylaxis. All but one patient required intubation and invasive positive pressure ventilation (PPV). Hospital mortality was associated with high APACHE III scores on day 1 (p = 0.05), intubation delay (p = 0.03), length of PPV (p = 0.003), and development of pneumothorax (p = 0.033). Logistic regression analysis demonstrated that association of intubation delay with hospital mortality persisted after adjusting for severity of illness (p = 0.03). Conclusions: Among patients with ARF secondary to non-HIV-related PCP, poor prognostic factors include high APACHE III scores, intubation delay, longer duration of PPV, and development of pneumothorax. None of the patients in this series received PCP prophylaxis prior to the development of pneumonia.

AB - Objective: To examine outcome and associated factors of acute respiratory failure (ARF) in non-HIV-related Pneumocystis pneumonia (PCP) in patients admitted to a medical ICU between 1995 and 2002. Design: A retrospective review of medical records and an APACHE (acute physiology and chronic health evaluation) III database. Setting: Academic tertiary medical center. Results: We identified 30 patients with non-HIV-related PCP and ARF. In-hospital, 6-month, and 1-year mortality rates were 67%, 77%, and 80%, respectively. Median age was 63.5 years. Median APACHE III score on day 1 was 65.5. Median ICU and hospital lengths of stay were 13 days and 21 days, respectively. All seven patients having a pneumothorax died. All but one patient had an elevated lactate dehydrogenase level (median, 563 U/L). The diagnosis was made using BAL in 28 patients and by transbronchial biopsy in the remaining 2 patients. All patients were immunosuppressed (eight were receiving corticosteroids, seven were receiving chemotherapy, and the remainder received both). Median immunosuppressive prednisone-equivalent dose was 40 mg (median length of treatment, 4.5 months). Not a single patient received PCP prophylaxis. All but one patient required intubation and invasive positive pressure ventilation (PPV). Hospital mortality was associated with high APACHE III scores on day 1 (p = 0.05), intubation delay (p = 0.03), length of PPV (p = 0.003), and development of pneumothorax (p = 0.033). Logistic regression analysis demonstrated that association of intubation delay with hospital mortality persisted after adjusting for severity of illness (p = 0.03). Conclusions: Among patients with ARF secondary to non-HIV-related PCP, poor prognostic factors include high APACHE III scores, intubation delay, longer duration of PPV, and development of pneumothorax. None of the patients in this series received PCP prophylaxis prior to the development of pneumonia.

KW - Acute respiratory failure

KW - ICU

KW - Pneumocystis pneumonia

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