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Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases

OBJECTIVES: To investigate short-term prognosis and prognostic factors for connective tissue disease-associated pneumocystis pneumonia (CTD-PCP) using the Japanese nationwide diagnosis procedure combination (DPC) inpatient database. METHODS: The present retrospective cohort study from April 2014 to...

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Autores principales: Ishikawa, Yuichi, Nakano, Kazuhisa, Tokutsu, Kei, Miyata, Hiroko, Fujino, Yoshihisa, Matsuda, Shinya, Tanaka, Yoshiya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944977/
https://www.ncbi.nlm.nih.gov/pubmed/33688083
http://dx.doi.org/10.1136/rmdopen-2020-001508
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author Ishikawa, Yuichi
Nakano, Kazuhisa
Tokutsu, Kei
Miyata, Hiroko
Fujino, Yoshihisa
Matsuda, Shinya
Tanaka, Yoshiya
author_facet Ishikawa, Yuichi
Nakano, Kazuhisa
Tokutsu, Kei
Miyata, Hiroko
Fujino, Yoshihisa
Matsuda, Shinya
Tanaka, Yoshiya
author_sort Ishikawa, Yuichi
collection PubMed
description OBJECTIVES: To investigate short-term prognosis and prognostic factors for connective tissue disease-associated pneumocystis pneumonia (CTD-PCP) using the Japanese nationwide diagnosis procedure combination (DPC) inpatient database. METHODS: The present retrospective cohort study from April 2014 to March 2016 included data of patients with CTD-PCP extracted from the DPC database using the 10(th) revision of International Classification of Diseases and Injuries codes. RESULTS: In 15 901 766 cases registered from 1329 hospitals, 333 of 67 890 patients who were admitted with PCP were diagnosed with CTD-PCP and included in the study. The median age was 71.0 years, and 214 (64.3%), 80 (24.0%), and 29 (8.7%) patients received sulfamethoxazole/trimethoprim (ST) monotherapy and pentamidine-containing and atovaquone-containing therapy, respectively. There were 114 (34.2%) in-hospital deaths, and the 30-day and 60-day in-hospital survival rates after PCP treatment initiation were 66.0% and 53.7%, respectively. Older age (HR 1.06, 95% CI 1.03 to 1.08) and concomitant interstitial lung disease (ILD) (HR 1.65, 95% CI 1.12 to 2.42) were poor prognostic factors. Patients who completed PCP treatment with ST monotherapy had a significantly higher survival rate than those treated with those not treated with ST monotherapy (p=0.015; log-rank test). Pentamidine versus atovaquone as second-line therapy was significantly higher with atovaquone (p=0.012; log-rank test). CONCLUSION: Older age and concomitant ILD were poor prognostic factors for CTD-PCP. ST was a reasonable first-line therapy in patients with CTD-PCP, and patients with inadequate response to ST treated with atovaquone tended to have a better prognosis than those treated with pentamidine.
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spelling pubmed-79449772021-03-28 Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases Ishikawa, Yuichi Nakano, Kazuhisa Tokutsu, Kei Miyata, Hiroko Fujino, Yoshihisa Matsuda, Shinya Tanaka, Yoshiya RMD Open Infections OBJECTIVES: To investigate short-term prognosis and prognostic factors for connective tissue disease-associated pneumocystis pneumonia (CTD-PCP) using the Japanese nationwide diagnosis procedure combination (DPC) inpatient database. METHODS: The present retrospective cohort study from April 2014 to March 2016 included data of patients with CTD-PCP extracted from the DPC database using the 10(th) revision of International Classification of Diseases and Injuries codes. RESULTS: In 15 901 766 cases registered from 1329 hospitals, 333 of 67 890 patients who were admitted with PCP were diagnosed with CTD-PCP and included in the study. The median age was 71.0 years, and 214 (64.3%), 80 (24.0%), and 29 (8.7%) patients received sulfamethoxazole/trimethoprim (ST) monotherapy and pentamidine-containing and atovaquone-containing therapy, respectively. There were 114 (34.2%) in-hospital deaths, and the 30-day and 60-day in-hospital survival rates after PCP treatment initiation were 66.0% and 53.7%, respectively. Older age (HR 1.06, 95% CI 1.03 to 1.08) and concomitant interstitial lung disease (ILD) (HR 1.65, 95% CI 1.12 to 2.42) were poor prognostic factors. Patients who completed PCP treatment with ST monotherapy had a significantly higher survival rate than those treated with those not treated with ST monotherapy (p=0.015; log-rank test). Pentamidine versus atovaquone as second-line therapy was significantly higher with atovaquone (p=0.012; log-rank test). CONCLUSION: Older age and concomitant ILD were poor prognostic factors for CTD-PCP. ST was a reasonable first-line therapy in patients with CTD-PCP, and patients with inadequate response to ST treated with atovaquone tended to have a better prognosis than those treated with pentamidine. BMJ Publishing Group 2021-03-09 /pmc/articles/PMC7944977/ /pubmed/33688083 http://dx.doi.org/10.1136/rmdopen-2020-001508 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Infections
Ishikawa, Yuichi
Nakano, Kazuhisa
Tokutsu, Kei
Miyata, Hiroko
Fujino, Yoshihisa
Matsuda, Shinya
Tanaka, Yoshiya
Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases
title Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases
title_full Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases
title_fullStr Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases
title_full_unstemmed Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases
title_short Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases
title_sort estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases
topic Infections
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944977/
https://www.ncbi.nlm.nih.gov/pubmed/33688083
http://dx.doi.org/10.1136/rmdopen-2020-001508
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