Predicting mortality from HIV-associated Pneumocystis pneumonia at illness presentation: an observational cohort study
- 1Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
- 2HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
- Correspondence to Dr M W Fei, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, 1001 Potrero Avenue, Room 5K1, San Francisco, CA 94110, USA; matt.w.fei{at}gmail.com
- Received 13 April 2009
- Accepted 11 September 2009
- Published Online First 12 October 2009
Abstract
Background: Although the use of antiretroviral therapy has led to dramatic declines in AIDS-associated mortality, Pneumocystis pneumonia (PCP) remains a leading cause of death in HIV-infected patients.
Objectives: To measure mortality, identify predictors of mortality at time of illness presentation and derive a PCP mortality prediction rule that stratifies patients by risk for mortality.
Methods: An observational cohort study with case note review of all HIV-infected persons with a laboratory diagnosis of PCP at San Francisco General Hospital from 1997 to 2006.
Results: 451 patients were diagnosed with PCP on 524 occasions. In-hospital mortality was 10.3%. Multivariate analysis identified five significant predictors of mortality: age (adjusted odds ratio (AOR) per 10-year increase, 1.69; 95% CI 1.08 to 2.65; p = 0.02); recent injection drug use (AOR 2.86; 95% CI 1.28 to 6.42; p = 0.01); total bilirubin >0.6 mg/dl (AOR 2.59; 95% CI 1.19 to 5.62; p = 0.02); serum albumin <3 g/dl (AOR 3.63; 95% CI 1.72–7.66; p = 0.001); and alveolar–arterial oxygen gradient ≥50 mm Hg (AOR 3.02; 95% CI 1.41 to 6.47; p = 0.004). Using these five predictors, a six-point PCP mortality prediction rule was derived that stratifies patients according to increasing risk of mortality: score 0–1, 4%; score 2–3, 12%; score 4–5, 48%.
Conclusions: The PCP mortality prediction rule stratifies patients by mortality risk at the time of illness presentation and should be validated as a clinical tool.
Footnotes
-
Funding This study was supported by National Institutes of Health Grants K24HL087713 and R01HL090335 (L.H), National Institutes of Health Grant F32HL088990 (J.L.D) and National Institutes of Health Grant T32HL007185 (M.W.F and E.J.K).
-
Competing interests None.
-
Provenance and peer review Not commissioned; externally peer reviewed.
-
Ethics approval Ethics committee approval was obtained from University of California, San Francisco Committee on Human Research.
