A combined immune and inflammatory indicator predict the prognosis of severe Pneumocystis jirovecii pneumonia patients: a 12-year, retrospective, observational cohort

BMC Pulm Med. 2024 Jun 18;24(1):285. doi: 10.1186/s12890-024-03093-8.

Abstract

Persistent inflammatory damage and suppressed immune function play a crucial role in the pathogenesis and progression of the pneumocystis jirovecii pneumonia (PjP). Therefore, we aimed to investigate the correlation between the combined immune and inflammatory indicator: the neutrophil-to-lymphocyte ratio (NLR) and prognosis of non-human immunodeficiency virus (non-HIV) PjP.In the retrospective analysis conducted in ICUs at Beijing Chao-Yang Hospital, we examined data from 157 patients diagnosed with non-HIV PjP. Our findings reveal a concerning hospital mortality rate of 43.3%, with the 28-day mortality rate reaching 47.8%.Through multivariable logistic and Cox regression analyses, we established a significant association between elevated NLR levels and hospital mortality (adjusted odd ratio, 1.025; 95% CI, 1.008-1.043; p = 0.004) or 28-day mortality (adjusted hazard ratio, 1.026; 95% CI, 1.008-1.045; p = 0.005). Specifically, patients with an NLR exceeding 20.3 demonstrated markedly lower overall survival rates, underscoring the biomarker's predictive value for both hospital and 28-day mortality.In conclusion, non-HIV PjP patients in the ICU still have a high rate of mortality and a poor short-term prognosis after discharge. A high level of NLR was associated with an increased risk of hospital mortality and 28-day mortality.

Keywords: Mortality; Neutrophil-to-lymphocyte ratio; Pneumocystis jirovecii pneumonia.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • China / epidemiology
  • Female
  • Hospital Mortality*
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Logistic Models
  • Lymphocytes
  • Male
  • Middle Aged
  • Neutrophils*
  • Pneumocystis carinii* / isolation & purification
  • Pneumonia, Pneumocystis* / diagnosis
  • Pneumonia, Pneumocystis* / immunology
  • Pneumonia, Pneumocystis* / mortality
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies

Substances

  • Biomarkers