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(Chest. 2002;122:253-261.)
© 2002 American College of Chest Physicians

Prognostic Factors of Non-HIV Immunocompromised Patients With Pulmonary Infiltrates*

Ana Rañó, MD, PhD; Carlos Agustí, MD, PhD; Natividad Benito, MD; Montserrat Rovira, MD, PhD; Joaquim Angrill, MD; Tomás Pumarola, MD, PhD and Antoni Torres, MD, PhD

* From the Servei de Pneumologia (Drs. Rañó, Agustí, Angrill, and Torres), Institut Clínic de Pneumología i Cirurgía Toràcica, Barcelona, Spain; and the Servei de Microbiologia i Malalties Infeccioses (Drs. Benito and Pumarola), Institut Clínic de Infeccions i Inmunitat, and the Servei d’Hematologia (Dr. Rovira), Institut d’Hematologia i Oncologia, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.

Correspondence to: Antoni Torres, MD, PhD, Servei de Pneumologia, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain; e-mail: atorres{at}medicina.ub.es

Study objectives: To assess the outcome and the prognostic factors in 200 non-HIV immunocompromised patients with pulmonary infiltrates (PIs).

Design: Prospective observational study.

Setting: An 800-bed university hospital.

Patients: Two hundred non-HIV immunocompromised patients (hematologic malignancies, 79 patients; hematopoietic stem cell transplants [HSCTs], 61 patients; and solid-organ transplants, 60 patients).

Methods: Investigation of prognostic factors related to mortality using a multiple logistic regression model.

Results: Specific diagnosis of the PI was obtained in 78% of the cases (infectious origin was determined in 74%). The overall mortality rate was 39% (78 of 200 patients). Patients with HSCT had the highest mortality rate (53%). A requirement for mechanical ventilation (odds ratio [OR], 28; 95% confidence interval [CI], 9 to 93), an APACHE (acute physiology and chronic health evaluation) II score of > 20 (OR, 5.5; 95% CI, 2 to 14.7), and a delay of > 5 days in establishing a specific diagnosis (OR, 3.4; 95% CI, 1.2 to 9.6) were the variables associated with mortality at the multivariate analysis. The subgroup analysis based on underlying disease confirmed the prognostic significance of these variables and the infectious etiology for the PI.

Conclusions: Mortality in immunocompromised patients is high, particularly in patients undergoing HSCT. Achieving an earlier diagnosis potentially may improve the mortality rate of these patients.

Key Words: immunosuppression • lung infection • mechanical ventilation • prognosis




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