Clinical characteristics and outcomes of immunocompromised patients with severe community-acquired pneumonia: A single-center retrospective cohort study

Xiaojing Wu; Ting Sun; Ying Cai; Tianshu Zhai; Yijie Liu; Sichao Gu; Yun Zhou; Qingyuan Zhan

doi:10.3389/fpubh.2023.1070581

Clinical characteristics and outcomes of immunocompromised patients with severe community-acquired pneumonia: A single-center retrospective cohort study

Front Public Health. 2023 Feb 15:11:1070581. doi: 10.3389/fpubh.2023.1070581. eCollection 2023.

Authors

Xiaojing Wu¹, Ting Sun², Ying Cai¹, Tianshu Zhai¹, Yijie Liu³, Sichao Gu¹, Yun Zhou⁴, Qingyuan Zhan^{1

2}

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
² Capital Medical University, China-Japan Friendship School of Clinical Medicine, Beijing, China.
³ Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
⁴ Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China.

Abstract

Background: Immunocompromised patients with severe community-acquired pneumonia (SCAP) warrant special attention because they comprise a growing proportion of patients and tend to have poor clinical outcomes. The objective of this study was to compare the characteristics and outcomes of immunocompromised and immunocompetent patients with SCAP, and to investigate the risk factors for mortality in these patients.

Methods: We conducted retrospective observational cohort study of patients aged ≥18 years admitted to the intensive care unit (ICU) of an academic tertiary hospital with SCAP between January 2017 and December 2019 and compared the clinical characteristics and outcomes of immunocompromised and immunocompetent patients.

Results: Among the 393 patients, 119 (30.3%) were immunocompromised. Corticosteroid (51.2%) and immunosuppressive drug (23.5%) therapies were the most common causes. Compared to immunocompetent patients, immunocompromised patients had a higher frequency of polymicrobial infection (56.6 vs. 27.5%, P < 0.001), early mortality (within 7 days) (26.1 vs. 13.1%, P = 0.002), and ICU mortality (49.6 vs. 37.6%, P = 0.027). The pathogen distributions differed between immunocompromised and immunocompetent patients. Among immunocompromised patients, Pneumocystis jirovecii and cytomegalovirus were the most common pathogens. Immunocompromised status (OR: 2.043, 95% CI: 1.114-3.748, P = 0.021) was an independent risk factor for ICU mortality. Independent risk factors for ICU mortality in immunocompromised patients included age ≥ 65 years (odds ratio [OR]: 9.098, 95% confidence interval [CI]: 1.472-56.234, P = 0.018), SOFA score [OR: 1.338, 95% CI: 1.048-1.708, P = 0.019), lymphocyte count < 0.8 × 10⁹/L (OR: 6.640, 95% CI: 1.463-30.141, P = 0.014), D-dimer level (OR: 1.160, 95% CI: 1.013-1.329, P = 0.032), FiO₂ > 0.7 (OR: 10.228, 95% CI: 1.992-52.531, P = 0.005), and lactate level (OR: 4.849, 95% CI: 1.701-13.825, P = 0.003).

Conclusions: Immunocompromised patients with SCAP have distinct clinical characteristics and risk factors that should be considered in their clinical evaluation and management.

Keywords: clinical characteristics; community-acquired pneumonia; immunocompromised status; intensive care unit; risk factor.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Coinfection*
Hospitalization
Humans
Immunocompromised Host
Pneumonia*
Retrospective Studies

Grants and funding

This work was supported by the National Natural Science Foundation of China (81870072), the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2022-I2M-JB-016), and the National High Level Hospital Clinical Research Funding (2022-NHLHCRF-LX-01).