Prognostic impact of pre-existing interstitial lung disease in non-HIV patients with Pneumocystis pneumonia

Shohei Hamada; Hidenori Ichiyasu; Megumi Inaba; Hiroshi Takahashi; Tomoki Sadamatsu; Kimitaka Akaike; Aiko Masunaga; Yasumasa Tashiro; Naomi Hirata; Takeshi Yoshinaga; Takuro Sakagami

doi:10.1183/23120541.00306-2019

Prognostic impact of pre-existing interstitial lung disease in non-HIV patients with Pneumocystis pneumonia

ERJ Open Res. 2020 May 4;6(2):00306-2019. doi: 10.1183/23120541.00306-2019. eCollection 2020 Apr.

Affiliations

¹ Dept of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
² Division of Respiratory Medicine, Kumamoto Chuo Hospital, Kumamoto, Japan.
³ Dept of Respiratory Medicine, Minamata City General Hospital and Medical Center, Minamata, Japan.

Abstract

Background: The increasing incidence of life-threatening Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients is a global concern. Yet, no reports have examined the prognostic significance of pre-existing interstitial lung disease (ILD) in non-HIV PCP.

Methods: We retrospectively reviewed the medical records of non-HIV PCP patients with (ILD group) or without (non-ILD group) pre-existing ILD. The clinical features and outcomes of the ILD group were compared with those of the non-ILD group. Cox regression models were constructed to identify prognostic factors.

Results: 74 patients were enrolled in this study. The 90-day mortality was significantly higher in the ILD group than in the non-ILD group (62.5% versus 19.0%, p<0.001). In the ILD group, patients with a higher percentage of bronchoalveolar lavage fluid neutrophils had worse outcomes compared to those having a lower percentage (p=0.026). Multivariate analyses revealed that pre-existing ILD (p=0.002) and low levels of serum albumin (p=0.009) were independent risk factors for 90-day mortality. Serum levels of β-d-glucan were significantly reduced after treatment of PCP in both groups, whereas levels of Krebs von den Lungen-6 (KL-6) significantly increased in the ILD group. In the ILD group, the 90-day mortality of patients with increasing KL-6 levels after treatment was significantly higher than those with decreasing levels (78.9% versus 0%, p=0.019).

Conclusion: In non-HIV PCP patients, pre-existing ILD is associated with a poorer prognosis. Prophylaxis for PCP is needed in patients with pre-existing ILD under immunosuppression.