Determinants of short- and long-term outcome in patients with respiratory failure caused by AIDS-related Pneumocystis carinii pneumonia

被引:28
|
作者
Forrest, DM
Zala, C
Djurdjev, O
Singer, J
Craib, KJP
Lawson, L
Russell, JA
Montaner, JSG
机构
[1] St Pauls Hosp, British Columbia Ctr Excellence HIV AIDS, Vancouver, BC V6Z 1Y6, Canada
[2] St Pauls Hosp, Dept Hlth Care & Epidemiol, Vancouver, BC V6Z 1Y6, Canada
[3] St Pauls Hosp, Dept Med, Vancouver, BC V6Z 1Y6, Canada
[4] Univ British Columbia, Div Crit Care Med, Vancouver, BC V5Z 1M9, Canada
[5] Univ British Columbia, Div Resp Med, Vancouver, BC V5Z 1M9, Canada
[6] Univ British Columbia, Fac Med, Vancouver, BC V5Z 1M9, Canada
[7] Canadian HIV Trials Network, Vancouver, BC, Canada
关键词
D O I
10.1001/archinte.159.7.741
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: To determine (1) predictors of in-hospital mortality and long-term survival in patients with acute respiratory failure (ARF) caused by acquired immunodeficiency syndrome-related Pneumocystis carinii pneumonia (PCP) and (2) long-term survival for patients with ARF relative to those without ARF. Methods: A retrospective medical chart review was conducted of all cases of PCP-related ARF for which the patient was admitted to the intensive care unit of a single tertiary care institution between 1991 and 1996. Data were extracted regarding physiologic scores, relevant laboratory values, and duration of previous maximal therapy with combined anti-PCP agents and corticosteroids at entry to the intensive care unit. Duration of survival was determined by Kaplan-Meier methods from date of first hospital admission and compared for patients with and without ARF. Results: There were 41 admissions to the intensive care unit among 39 patients, with 56.4% in-hospital mortality. Higher physiologic scores (Acute Physiology and Chronic Health Evaluation II [APACHE II]. Acute Lung Injury, and modified Multisystem Organ Failure scores) were predictive of in-hospital mortality. Duration of previous maximal therapy also predicted in-hospital mortality (45% for patients with <5 days of previous maximal therapy vs 88% for those with greater than or equal to 5 days of previous maximal therapy; P = .03). Combining physiologic scores and duration of previous maximal therapy enhanced prediction of in-hospital mortality. There was no difference in long-term survival between patients with PCP with ARF and those without ARF (P = .80), and baseline characteristics did not predict long-term survival. Conclusions: In-hospital mortality of patients with acquired immunodeficiency syndrome-related PCP and ARF is predicted by duration of previous maximal therapy and physiologic scores, and their combination enhances predictive accuracy. Long-term survival of patients with ARF caused by PCP is comparable to that of patients with PCP who do not develop ARF, and determinants of in-hospital mortality do not predict longterm survival.
引用
收藏
页码:741 / 747
页数:7
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