Adjunctive steroid in HIV-negative patients with severe Pneumocystis pneumonia

作者：Lemiale Virginie^*; Debrumetz Alexandre; Delannoy Alexandra; Alberti Corinne; Azoulay Elie

来源：Respiratory Research, 2013, 14(1): 87.

DOI：10.1186/1465-9921-14-87

• Pneumocystis jiroveci infection
• Immunocompromised host
• Mortality

Background: High-dose steroid therapy has been proven effective in AIDS-related Pneumocystis pneumonia (PCP) but not in non-AIDS-related cases. We evaluated the effects on survival of steroids in HIV-negative patients with PCP. %26lt;br%26gt;Methods: Retrospective study patients admitted to the ICU with hypoxemic PCP. We compared patients receiving HDS (%26gt;= 1 mg/Kg/day prednisone equivalent), low-dose steroids (LDS group, %26lt;1 mg/Kg/day prednisone equivalent), and no steroids (NS group). Variables independently associated with ICU mortality were identified. %26lt;br%26gt;Results: 139 HIV-negative patients with PCP were included. Median age was 48 [40-60] years. The main underlying conditions were hematological malignancies (n=55, 39.6%), cancer (n=11, 7.9%), and solid organ transplantation (n=73, 52.2%). ICU mortality was 26% (36 deaths). The HDS group had 72 (51.8%) patients, the LDS group 35 (25%) patients, and the NS group 32 (23%) patients. Independent predictors of ICU mortality were SAPS II at ICU admission (odds ratio [OR], 1.04/point; [95%CI], 1.01-1.08, P=0.01), non-hematological disease (OR, 4.06; [95%CI], 1.19-13.09, P=0.03), vasopressor use (OR, 20.31; 95%CI, 6.45-63.9, P%26lt;0.001), and HDS (OR, 9.33; 95%CI, 1.97-44.3, P=0.02). HDS was not associated with the rate of ICU-acquired infections. %26lt;br%26gt;Conclusions: HDS were associated with increased mortality in HIV-negative patients with PCP via a mechanism independent from an increased risk of infection.

• 出版日期2013-8-28