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Prognostic factors of Pneumocystis pneumonia in patients with systemic autoimmune diseases

Pneumocystis pneumonia (PCP) is one of the most common opportunistic infections. In systemic autoimmune disease patients receiving immunosuppressive treatments, low lymphocyte count, old age and coexisting lung disease have been known as risk factors for the occurrence of PCP. However, factors relev... Full description

Journal Title: PloS one 2019, Vol.14(3), pp.e0214324
Main Author: Kageyama, Takahiro
Other Authors: Furuta, Shunsuke , Ikeda, Kei , Kagami, Shin-Ichiro , Kashiwakuma, Daisuke , Sugiyama, Takao , Umibe, Takeshi , Watanabe, Norihiko , Yamagata, Mieko , Nakajima, Hiroshi
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: E-ISSN: 1932-6203 ; PMID: 30908547 Version:1 ; DOI: 10.1371/journal.pone.0214324
Link: http://pubmed.gov/30908547
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recordid: medline30908547
title: Prognostic factors of Pneumocystis pneumonia in patients with systemic autoimmune diseases
format: Article
creator:
  • Kageyama, Takahiro
  • Furuta, Shunsuke
  • Ikeda, Kei
  • Kagami, Shin-Ichiro
  • Kashiwakuma, Daisuke
  • Sugiyama, Takao
  • Umibe, Takeshi
  • Watanabe, Norihiko
  • Yamagata, Mieko
  • Nakajima, Hiroshi
subjects:
  • Autoimmune Diseases -- Drug Therapy
  • Immunosuppressive Agents -- Therapeutic Use
  • Lung Diseases -- Diagnosis
  • Opportunistic Infections -- Diagnosis
  • Pneumonia, Pneumocystis -- Diagnosis
ispartof: PloS one, 2019, Vol.14(3), pp.e0214324
description: Pneumocystis pneumonia (PCP) is one of the most common opportunistic infections. In systemic autoimmune disease patients receiving immunosuppressive treatments, low lymphocyte count, old age and coexisting lung disease have been known as risk factors for the occurrence of PCP. However, factors relevant to prognosis of PCP have not been fully studied. A total of 95 sequential patients who developed PCP during immunosuppressive treatment for systemic autoimmune diseases was identified from five Japanese centres. We retrospectively assessed baseline characteristics, immunosuppressive treatment prior to the onset of PCP, treatment for PCP and survival. Univariate and multivariate analyses were performed to identify prognostic factors. Forty-two deaths (44.2%) were observed in this study. Age at the diagnosis of PCP was higher in non-survivors than in survivors (74 years vs. 64 years, p = 0.008). Non-survivors more frequently had lung involvement than did survivors (47.6% vs. 13.2%, p
language: eng
source:
identifier: E-ISSN: 1932-6203 ; PMID: 30908547 Version:1 ; DOI: 10.1371/journal.pone.0214324
fulltext: fulltext
issn:
  • 19326203
  • 1932-6203
url: Link


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titlePrognostic factors of Pneumocystis pneumonia in patients with systemic autoimmune diseases
creatorKageyama, Takahiro ; Furuta, Shunsuke ; Ikeda, Kei ; Kagami, Shin-Ichiro ; Kashiwakuma, Daisuke ; Sugiyama, Takao ; Umibe, Takeshi ; Watanabe, Norihiko ; Yamagata, Mieko ; Nakajima, Hiroshi
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subjectAutoimmune Diseases -- Drug Therapy ; Immunosuppressive Agents -- Therapeutic Use ; Lung Diseases -- Diagnosis ; Opportunistic Infections -- Diagnosis ; Pneumonia, Pneumocystis -- Diagnosis
descriptionPneumocystis pneumonia (PCP) is one of the most common opportunistic infections. In systemic autoimmune disease patients receiving immunosuppressive treatments, low lymphocyte count, old age and coexisting lung disease have been known as risk factors for the occurrence of PCP. However, factors relevant to prognosis of PCP have not been fully studied. A total of 95 sequential patients who developed PCP during immunosuppressive treatment for systemic autoimmune diseases was identified from five Japanese centres. We retrospectively assessed baseline characteristics, immunosuppressive treatment prior to the onset of PCP, treatment for PCP and survival. Univariate and multivariate analyses were performed to identify prognostic factors. Forty-two deaths (44.2%) were observed in this study. Age at the diagnosis of PCP was higher in non-survivors than in survivors (74 years vs. 64 years, p = 0.008). Non-survivors more frequently had lung involvement than did survivors (47.6% vs. 13.2%, p<0.001). Median lymphocyte count at the diagnosis of PCP was lower in non-survivors than in survivors (499/μl vs. 874/μl, p = 0.002). Multivariate analysis identified lower lymphocyte count, older age and coexisting lung disease at the diagnosis of PCP as independent risk factors for death. Those risk factors for death were similar to the known risk factors for the occurrence of PCP. Although PCP can occur even in patients without these risk factors, our data demonstrate that the overall prognosis of PCP in such patients is good. Given that the standard prophylactic treatment against PCP has safety issues, the risk-stratified use of prophylactic treatment may be advisable.
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titlePrognostic factors of Pneumocystis pneumonia in patients with systemic autoimmune diseases
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0Pneumocystis pneumonia (PCP) is one of the most common opportunistic infections. In systemic autoimmune disease patients receiving immunosuppressive treatments, low lymphocyte count, old age and coexisting lung disease have been known as risk factors for the occurrence of PCP. However, factors relevant to prognosis of PCP have not been fully studied.
1A total of 95 sequential patients who developed PCP during immunosuppressive treatment for systemic autoimmune diseases was identified from five Japanese centres. We retrospectively assessed baseline characteristics, immunosuppressive treatment prior to the onset of PCP, treatment for PCP and survival. Univariate and multivariate analyses were performed to identify prognostic factors.
2Forty-two deaths (44.2%) were observed in this study. Age at the diagnosis of PCP was higher in non-survivors than in survivors (74 years vs. 64 years, p = 0.008). Non-survivors more frequently had lung involvement than did survivors (47.6% vs. 13.2%, p<0.001). Median lymphocyte count at the diagnosis of PCP was lower in non-survivors than in survivors (499/μl vs. 874/μl, p = 0.002). Multivariate analysis identified lower lymphocyte count, older age and coexisting lung disease at the diagnosis of PCP as independent risk factors for death. Those risk factors for death were similar to the known risk factors for the occurrence of PCP.
3Although PCP can occur even in patients without these risk factors, our data demonstrate that the overall prognosis of PCP in such patients is good. Given that the standard prophylactic treatment against PCP has safety issues, the risk-stratified use of prophylactic treatment may be advisable.
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titlePrognostic factors of Pneumocystis pneumonia in patients with systemic autoimmune diseases
authorKageyama, Takahiro ; Furuta, Shunsuke ; Ikeda, Kei ; Kagami, Shin-Ichiro ; Kashiwakuma, Daisuke ; Sugiyama, Takao ; Umibe, Takeshi ; Watanabe, Norihiko ; Yamagata, Mieko ; Nakajima, Hiroshi
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abstractPneumocystis pneumonia (PCP) is one of the most common opportunistic infections. In systemic autoimmune disease patients receiving immunosuppressive treatments, low lymphocyte count, old age and coexisting lung disease have been known as risk factors for the occurrence of PCP. However, factors relevant to prognosis of PCP have not been fully studied.
doi10.1371/journal.pone.0214324
pmid30908547