Blood urea nitrogen-to-serum albumin ratio and A-DROP are useful in assessing the severity of Pneumocystis pneumonia in patients without human immunodeficiency virus infection

被引:21
作者
Akahane, Jumpei [1 ]
Ushiki, Atsuhito [1 ]
Kosaka, Makoto [2 ]
Ikuyama, Yuichi [1 ]
Matsuo, Akemi [3 ]
Hachiya, Tsutomu [4 ]
Yoshiike, Fumiaki [5 ]
Koyama, Shigeru [6 ]
Hanaoka, Masayuki [1 ]
机构
[1] Shinshu Univ, Dept Internal Med 1, Sch Med, 3-1-1 Asahi Matsumoto City, Nagano 3908621, Japan
[2] Nagano Prefectural Shinshu Med Ctr, Ctr Infect Dis, 1332 Suzaka, Suzaka City, Nagano 3828577, Japan
[3] Shinonoi Gen Hosp, Minaminagano Med Ctr, Dept Resp Med, 666-1 Ai, Nagano, Nagano 3888004, Japan
[4] Japanese Red Cross Soc Suwa Hosp, Dept Resp Med, 5-11-50 Kogandori, Suwa, Nagano 3928510, Japan
[5] Nagano Municipal Hosp, Dept Resp Med, 1333-1 Tomitake, Nagano, Nagano 3818551, Japan
[6] Japanese Red Cross Soc Nagano Hosp, Dept Resp Med, 5-22-1 Wakasato, Nagano, Nagano 3808582, Japan
关键词
Pneumocystis pneumonia; Prognostic factors; A-DROP; Blood urea nitrogen-to-serum albumin ratio; COMMUNITY-ACQUIRED PNEUMONIA; JIROVECII PNEUMONIA; CARINII-PNEUMONIA; MANAGEMENT; GUIDELINES; DIAGNOSIS; AIDS;
D O I
10.1016/j.jiac.2020.12.017
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Introduction: There is an increasing incidence of Pneumocystis pneumonia (PcP) among individuals without human immunodeficiency virus (HIV) infection (non-HIV PcP). However, prognostic factors for patients with non-HIV PcP have not been identified. Moreover, A-DROP (for classifying the severity of community-acquired pneumonia) or the blood urea nitrogen-to-serum albumin ratio (BUN/Alb), which is reported to be a predictor of mortality of community-acquired pneumonia, has not been established as an efficient prognostic factor in patients with non-HIV PcP. In this study, we analyzed the prognostic factors for non-HIV PcP and evaluated the prognostic ability of A-DROP and the BUN/Alb ratio. Methods: This retrospective study involved a chart review of the medical records of 102 patients diagnosed with non-HIV PcP between January 2003 and May 2019 at five medical facilities. Results: Overall, 102 patients were involved in this study. The 30-day mortality rate for non-HIV PcP was 20.5% in this study population. Compared with survivors, non-survivors had significantly lower serum albumin levels and significantly higher age, corticosteroid dosage at the PcP onset, alveolar-arterial oxygen gradient, A-DROP score, lactate dehydrogenase levels, blood urea nitrogen levels, and BUN/Alb ratio. Multivariate analysis showed that a high BUN/Alb ratio at treatment initiation was significantly associated with 30-day mortality risk. The receiver operating characteristic curves showed that A-DROP score had the highest prognostic ability in estimating 30-day mortality. Conclusions: In patients with non-HIV PcP, a high BUN/Alb ratio is an independent prognostic predictor of mortality risk, and A-DROP is useful for classifying the severity. (c) 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:707 / 714
页数:8
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