Cargando…
Pneumocystis jirovecii Pneumonia in Patients with Nephrotic Syndrome: Application of Lymphocyte Subset Analysis in Predicting Clinical Outcomes
PURPOSE: With immunosuppressants being widely used, Pneumocystis jirovecii pneumonia (PCP) has been increasing and could be life-threatening among HIV-negative patients. This study aimed at identifying prognostic factors of PCP in patients with nephrotic syndrome. METHODS: We retrospectively investi...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054770/ https://www.ncbi.nlm.nih.gov/pubmed/32148596 http://dx.doi.org/10.1155/2020/4631297 |
_version_ | 1783503252926496768 |
---|---|
author | Liu, Yang Zheng, Ke Liu, Yecheng Zhu, Huadong |
author_facet | Liu, Yang Zheng, Ke Liu, Yecheng Zhu, Huadong |
author_sort | Liu, Yang |
collection | PubMed |
description | PURPOSE: With immunosuppressants being widely used, Pneumocystis jirovecii pneumonia (PCP) has been increasing and could be life-threatening among HIV-negative patients. This study aimed at identifying prognostic factors of PCP in patients with nephrotic syndrome. METHODS: We retrospectively investigated patients with nephrotic syndrome who were diagnosed with PCP. The diagnosis of PCP was based on clinical manifestations, radiological findings, and microbiological confirmatory tests. Predictors of outcome were determined with multivariate logistic regression analysis. RESULTS: A total of 57 patients were included in this study. The PCP mortality was 33.3%, which increased to 48.6% if ICU admission was required and to 60% when mechanical ventilation was needed. The T lymphocyte count and CD4/CD8 ratio independently predicted the outcome of PCP, so did the CD4(+) T lymphocyte count (OR, 0.981; 95% CI, 0.967–0.996; p=0.001). The cut-off value of 71 cells/μl for the CD4(+) T lymphocyte count was determined to identify patients with poor prognosis. No association was found between PCP mortality and the type of immunosuppressant used. CONCLUSIONS: PCP is a fatal complication among nephrotic syndrome patients receiving immunosuppressive therapy. The CD4(+) T lymphocyte count is suggested as an independent predictor of prognosis, which can be used clinically to identify patients with high risk of unfavorable outcomes. |
format | Online Article Text |
id | pubmed-7054770 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-70547702020-03-07 Pneumocystis jirovecii Pneumonia in Patients with Nephrotic Syndrome: Application of Lymphocyte Subset Analysis in Predicting Clinical Outcomes Liu, Yang Zheng, Ke Liu, Yecheng Zhu, Huadong Can J Infect Dis Med Microbiol Research Article PURPOSE: With immunosuppressants being widely used, Pneumocystis jirovecii pneumonia (PCP) has been increasing and could be life-threatening among HIV-negative patients. This study aimed at identifying prognostic factors of PCP in patients with nephrotic syndrome. METHODS: We retrospectively investigated patients with nephrotic syndrome who were diagnosed with PCP. The diagnosis of PCP was based on clinical manifestations, radiological findings, and microbiological confirmatory tests. Predictors of outcome were determined with multivariate logistic regression analysis. RESULTS: A total of 57 patients were included in this study. The PCP mortality was 33.3%, which increased to 48.6% if ICU admission was required and to 60% when mechanical ventilation was needed. The T lymphocyte count and CD4/CD8 ratio independently predicted the outcome of PCP, so did the CD4(+) T lymphocyte count (OR, 0.981; 95% CI, 0.967–0.996; p=0.001). The cut-off value of 71 cells/μl for the CD4(+) T lymphocyte count was determined to identify patients with poor prognosis. No association was found between PCP mortality and the type of immunosuppressant used. CONCLUSIONS: PCP is a fatal complication among nephrotic syndrome patients receiving immunosuppressive therapy. The CD4(+) T lymphocyte count is suggested as an independent predictor of prognosis, which can be used clinically to identify patients with high risk of unfavorable outcomes. Hindawi 2020-02-20 /pmc/articles/PMC7054770/ /pubmed/32148596 http://dx.doi.org/10.1155/2020/4631297 Text en Copyright © 2020 Yang Liu et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Liu, Yang Zheng, Ke Liu, Yecheng Zhu, Huadong Pneumocystis jirovecii Pneumonia in Patients with Nephrotic Syndrome: Application of Lymphocyte Subset Analysis in Predicting Clinical Outcomes |
title |
Pneumocystis jirovecii Pneumonia in Patients with Nephrotic Syndrome: Application of Lymphocyte Subset Analysis in Predicting Clinical Outcomes |
title_full |
Pneumocystis jirovecii Pneumonia in Patients with Nephrotic Syndrome: Application of Lymphocyte Subset Analysis in Predicting Clinical Outcomes |
title_fullStr |
Pneumocystis jirovecii Pneumonia in Patients with Nephrotic Syndrome: Application of Lymphocyte Subset Analysis in Predicting Clinical Outcomes |
title_full_unstemmed |
Pneumocystis jirovecii Pneumonia in Patients with Nephrotic Syndrome: Application of Lymphocyte Subset Analysis in Predicting Clinical Outcomes |
title_short |
Pneumocystis jirovecii Pneumonia in Patients with Nephrotic Syndrome: Application of Lymphocyte Subset Analysis in Predicting Clinical Outcomes |
title_sort | pneumocystis jirovecii pneumonia in patients with nephrotic syndrome: application of lymphocyte subset analysis in predicting clinical outcomes |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054770/ https://www.ncbi.nlm.nih.gov/pubmed/32148596 http://dx.doi.org/10.1155/2020/4631297 |
work_keys_str_mv | AT liuyang pneumocystisjiroveciipneumoniainpatientswithnephroticsyndromeapplicationoflymphocytesubsetanalysisinpredictingclinicaloutcomes AT zhengke pneumocystisjiroveciipneumoniainpatientswithnephroticsyndromeapplicationoflymphocytesubsetanalysisinpredictingclinicaloutcomes AT liuyecheng pneumocystisjiroveciipneumoniainpatientswithnephroticsyndromeapplicationoflymphocytesubsetanalysisinpredictingclinicaloutcomes AT zhuhuadong pneumocystisjiroveciipneumoniainpatientswithnephroticsyndromeapplicationoflymphocytesubsetanalysisinpredictingclinicaloutcomes |