Objective: To investigate the clinical manifestations and prognostic factors of hospital death in connective tissue disease patients with acute respiratory failure caused by pneumocystis pneumonia (PCP) admitted to two medical intensive care units(MICU). Methods: A retrospective review was conducted for all connective tissue disease (CTD) patients with acute respiratory failure from PCP in MICU of 2 academic medical centers between 2010 and 2015. The patients were divided into survivors and non-survivors. Demographic and clinical data, including laboratory, radiological and microbiological findings, as well as therapy, clinical course, mortality and prognostic factors of hospital mortality were included in the analysis. Logistic regression models were used to determine the effect of prognostic factors on hospital death after adjusting for covariates of which the p values were less than 0.1. Results: A total of 41 patients with connective tissue disease were identified. The PaO(2)/FiO(2) ratio (PFR) on ICU admission was 120 mmHg(55-180 mmHg, 1 mmHg=0.133 kPa). Common clinical features included dyspnea (90.2%, 37/41), fever (87.8%, 36/41) and dry cough(65.9%, 30/41). 58.5%(24/41) and 17.1%(7/41) patients were co-infected by CMV and aspergillus, respectively. The overall mortality rate was 75.6%(31/41). Compared with survivors, the age, APACHEⅡ score and incidence of barotrauma in non-survivors were higher (39±17 vs 58±15, t=3.018, P=0.002), (15±6 vs 19±5, t=2.528, P=0.019), (0/10 vs 12/31, χ(2)=5.473, P=0.021), while PFR on ICU admission was lower in non-survivors (172±68 vs 116±49, t=-1.893, P=0.007). Logistic analysis showed that PFR on ICU admission was the independent risk factor for hospital death (OR=1.004, 95%CI: 1.002-1.006, P=0.048). Conclusions: Mortality rate among patients with acute respiratory failure secondary to CTD related PCP is still high, and the poor prognostic factors of hospital mortality included PFR on ICU admission and barotrauma.
目的： 探讨结缔组织病肺孢子菌肺炎(PCP)合并急性呼吸衰竭(ARF)患者的临床特点和预后因素。 方法： 回顾性研究中日友好医院和北京协和医院内科重症监护病房(MICU)2010—2015年41例结缔组织病PCP合并ARF患者的临床资料，根据出院时的预后情况分为存活组和病死组，搜集患者的基础疾病、临床表现、实验室检查、影像学特征、药物治疗、并发症以及住院死亡等相关指标，采用单因素和logistic多因素回归分析死亡高危因素。 结果： 41例患者住院病死率为75.6%(31/41)，入ICU时氧合指数中位数为120(55～180)mmHg(1 mmHg＝0.133 kPa)。主要临床表现为呼吸困难(90.2%，37/41)、发热(87.8%，36/41)和干咳(65.9%，30/41)。合并巨细胞病毒(CMV)肺炎和侵袭性支气管肺曲霉病的比例分别为58.5%(24/41)和17.1%(7/41)。病死组年龄为(58±15)岁，高于存活组的(39±17)岁(t＝3.018, P＝0.002)；病死组入ICU急性生理和慢性健康评分(APACHEⅡ评分)为19±5，高于存活组的15±6(t＝2.528, P＝0.019)；病死组气压伤发生率(12/31)高于存活组(0/10)，差异有统计学意义(χ(2)＝5.473，P＝0.021)，病死组入ICU时氧合指数(116±49)低于存活组(172±68)，差异有统计学意义(t＝－1.893，P＝0.007)。logistic多元回归分析结果提示入ICU时氧合指数是死亡的独立危险因素(OR＝1.004, 95% CI为1.002～1.006，P＝0.048)。 结论： 结缔组织病患者PCP合并ARF后病死率高，入ICU时低氧合指数和发生气压伤是死亡的高危因素。.
Keywords: Connective tissue disease; Immunocompromised; Pneumonia, pneumocystis; Respiratory insufficiency.