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Prognostic Markers of Short-term Mortality in AIDS-Associated Pneumocystis carinii Pneumonia^*

^* From the Departments of Infectious Diseases (Drs. Benfield, Helweg-Larsen, Bang, and Lundgren) and Pathology (Dr. Junge), University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark.

Correspondence to: Thomas L. Benfield, MD, Department of Infectious Diseases 144, University of Copenhagen, Hvidovre Hospital, DK-2650 Hvidovre, Denmark; e-mail: tbenfield{at}inet.uni2.dk

Background: Since 1990, corticosteroids have been recommended as adjunctive therapy for patients with AIDS-associated Pneumocystis carinii pneumonia (PCP) and respiratory failure. We hypothesized that the natural course of AIDS-associated PCP has changed in the era of adjunctive corticosteroid therapy.

Objective: To study variables obtained on hospital admission for possible prognostic value of short-term (3-month) outcome of PCP.

Design and patients: Prospective observational study of 176 consecutive HIV-1–infected individuals with PCP between 1990 and 1999.

Method: Cox proportional-hazards regression models.

Results: Univariate analysis showed that age, one or more prior episodes of PCP, use of antimicrobial therapy other than trimethoprim-sulfamethoxazole (TMP-SMZ), use of PCP prophylaxis at diagnosis, and culture of cytomegalovirus (CMV) in BAL predicted progression to death within 3 months. After adjustment, age (relative risk [RR], 4.1; 95% confidence interval [CI], 1.8 to 9.3), initial antimicrobial therapy other than TMP-SMZ (RR, 3.1; 95% CI, 1.2 to 8.5), use of PCP prophylaxis (RR, 5.6; 95% CI, 2.2 to 14.4), and culture of CMV in BAL fluid (RR, 2.7; 95% CI, 1.3 to 5.6) remained independent predictors of a poor outcome. In contrast, neither PO₂ nor serum lactate dehydrogenase, which in earlier studies were identified as prognostic markers, were predictors of mortality.

Conclusion: Age, initial anti-PCP therapy, use of PCP prophylaxis, and BAL CMV status may be useful predictors of outcome of PCP in patients treated in the era of adjunctive corticosteroid therapy.

Key Words: Pneumocystis carinii pneumonia • prognosis • survival

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