Characteristics and Prognosis Factors of Pneumocystis jirovecii Pneumonia According to Underlying Disease: A Retrospective Multicenter Study

Romain Lécuyer; Nahéma Issa; Fabrice Camou; Rose-Anne Lavergne; Frederic Gabriel; Florent Morio; Emmanuel Canet; François Raffi; David Boutoille; Anne Cady; Marie Gousseff; Yoann Crabol; Antoine Néel; Benoît Tessoulin; Benjamin Gaborit; PRONOCYSTIS Study Group

doi:10.1016/j.chest.2024.01.015

Characteristics and Prognosis Factors of Pneumocystis jirovecii Pneumonia According to Underlying Disease: A Retrospective Multicenter Study

Chest. 2024 Jan 11:S0012-3692(24)00022-9. doi: 10.1016/j.chest.2024.01.015. Online ahead of print.

Authors

Collaborators

PRONOCYSTIS Study Group:
Francois Raffi, David Boutoille, Charlotte Biron, Maeva Lefebvre, Benjamin Jean Gaborit, Paul Le Turnier, Colin Deschanvres, Raphael Lecomte, Marie Chauveau, Romain Lécuyer, Antoine Asquier-Khati, Patrice Le Pape, Florent Morio, Rose-Anne Lavergne, Fakhri Jeddi, Stéphane Corvec, Pascale Bemer, Jocelyne Caillon, Aurélie Guillouzouic, Anne-Gaëlle Leroy, Karim Lakhal, Raphaël Cinotti, Antoine Roquilly, Jean Reignier Emmanuel Canet, François Xavier Blanc, Cédric Bretonniere, Paul Morin, Fabrice Camou, Nahéma Issa, Olivier Guisset, Gaelle Mourissoux, Isabelle Accoceberry, Frederic Gabriel, Isabelle Accoceberry, Noémie Coron, Laurence Delhaes, Sébastien Imbert, Maxime Lefranc, Florian Lussac-Sorton, Amandine Rougeron, Marie Gousseff, Yoann Crabol, Grégory Corvaisier, Florent Lautredoux, Romain Lécuyer, Anne Cady, Myriam Auger, Pascal Pouedras

Affiliations

¹ Internal Medicine and Infectious Diseases, Centre Hospitalier Bretagne-Atlantique, Vannes, France; Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, UR1155, Nantes, France.
² Intensive Care and Infectious Disease Unit, Groupe Saint-André, University Hospital, Bordeaux, France.
³ Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, UR1155, Nantes, France.
⁴ Centre Hospitalier Universitaire de Bordeaux, Service de Parasitologie Mycologie, Bordeaux, France.
⁵ Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, UR1155, Nantes, France; Laboratoire de Parasitologie-Mycologie, Institut de Biologie, University Hospital, Nantes, France.
⁶ Medical Intensive Care, University Hospital, Nantes, France.
⁷ Department of Infectious Diseases, University Hospital of Nantes and Centre d'Investigation Clinique 1413, INSERM, Nantes, France.
⁸ Department of Infectious Diseases, University Hospital of Nantes and Centre d'Investigation Clinique 1413, INSERM, Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France.
⁹ Department of Microbiology, Centre Hospitalier Bretagne-Atlantique, Vannes, France.
¹⁰ Internal Medicine and Infectious Diseases, Centre Hospitalier Bretagne-Atlantique, Vannes, France.
¹¹ CRTI UMR 1064, INSERM, Université de Nantes, Nantes, France; Department of Internal Medicine, University Hospital, Nantes, France.
¹² INSERM, U1232, Hematology Department, Nantes University Hospital, CRCI(2)NA, Nantes University, Nantes, France.
¹³ Department of Infectious Diseases, University Hospital of Nantes and Centre d'Investigation Clinique 1413, INSERM, Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France. Electronic address: benjamin.gaborit@chu-nantes.fr.

PMID: 38215935
DOI: 10.1016/j.chest.2024.01.015

Abstract

Background: Pneumocystis jirovecii pneumonia (PcP) remains associated with high rates of mortality, and the impact of immunocompromising underlying disease on the clinical presentation, severity, and mortality of PcP has not been adequately evaluated.

Research question: Does the underlying disease and immunosuppression causing PcP impact the outcome and clinical presentation of the disease?

Study design and methods: In this multicenter retrospective observational study, conducted from January 2011 to December 2021, all consecutive patients admitted with a proven or probable diagnosis of PcP according to The European Organisation for Research and Treatment of Cancer consensus definitions were included to assess the epidemiology and impact of underlying immunosuppressive diseases on overall and 90-day mortality.

Results: Overall, 481 patients were included in the study; 180 (37.4%) were defined as proven PcP and 301 (62.6%) were defined as probable PcP. Patients with immune-mediated inflammatory diseases (IMIDs) or solid tumors had a statistically poorer prognosis than other patients with PcP at day 90. In multivariate analysis, among the HIV-negative population, solid tumor underlying disease (OR, 5.47; 95% CI, 2.16-14.1; P < .001), IMIDs (OR, 2.19; 95% CI, 1.05-4.60; P = .037), long-term corticosteroid exposure (OR, 2.07; 95% CI, 1.03-4.31; P = .045), cysts in sputum/BAL smears (OR, 1.92; 95% CI, 1.02-3.62; P = .043), and SOFA score at admission (OR, 1.58; 95% CI, 1.39-1.82; P < .001) were independently associated with 90-day mortality. Prior corticotherapy was the only immunosuppressant associated with 90-day mortality (OR, 1.67; 95% CI, 1.03-2.71; P = .035), especially for a prednisone daily dose ≥ 10 mg (OR, 1.80; 95% CI, 1.14-2.85; P = .010).

Interpretation: Among patients who were HIV-negative, long-term corticosteroid prior to PcP diagnosis was independently associated with increased 90-day mortality, specifically in patients with IMIDs. These results highlight both the needs for PcP prophylaxis in patients with IMIDs and to early consider PcP curative treatment in severe pneumonia among patients with IMIDs.

Keywords: Pneumocystis jirovecii pneumonia; corticosteroids; immune-mediated inflammatory diseases; outcome; solid tumors.