Use of Adjunctive Corticosteroids in Severe Adult Non-HIV Pneumocystis carinii Pneumonia

¹ From the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston

Study objective: To examine the use of adjunctive corticosteroids in cases of severe Pneumocystis carinii pneumonia (PCP) in non-HIV-infected adult patients.

Design: Retrospective review of medical records.

Setting: Tertiary care urban teaching hospital.

Patients: Review identified 31 consecutive histologically confirmed primary cases of adult non-HIV-related PCP. Complete records were available for 30 patients, including 20 male and 10 female patients with a mean age of 58.3±15 years (±SD). Underlying conditions included organ transplantation (n=13), long-term immunosuppressive therapy (n=9), and chemotherapy for malignancy (n=8). All patients had documented PO₂ <65 mm Hg or arterial oxygen saturation <90% on room air.

Interventions: Following the identification of P carinii, in addition to trimethoprim-sulfamethoxazole or pentamidine therapy, 16 patients received increased steroids (60 mg prednisone daily equivalent; increased high-dose steroid group), whereas 14 patients were maintained on a regimen of low doses (30 mg prednisone equivalent daily) or had steroid therapy tapered (low-dose steroid group).

Results: The increased high-dose steroid group demonstrated a shorter required duration for mechanical ventilation (6.3±6 days vs 18.0±21 days; p=0.047), a shorter duration of ICU admission (8.5±7 days vs 15.8±8 days; p=0.025), and a shorter duration of supplemental oxygen use (10.0±4 vs 32.2±33; p=0.05). The hospital duration to discharge for the nine survivors in each group favored the use of corticosteroids (15.4±5 days vs 36.3±33 days; p=0.077). Similar rates were observed for intubation (75% vs 57%; p=0.442) and in-hospital mortality (44% vs 36%; p=0.722).

Conclusions: These preliminary data suggest that high-dose adjunctive corticosteroids may accelerate recovery in cases of severe adult non-HIV PCP.

Key Words: corticosteroids • immunosuppression • mortality • Pneumocystis carinii pneumonia • respiratory failure

Submitted on April 7, 1997
Accepted on October 31, 1997

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