Influencing factors on the progression of acquired immunodeficiency syndrome patients with Pneumocystis carinii pneumonia

doi:10.3877/cma.j.issn.1674-1358.2019.05.009

Abstract

Abstract:

Objective

To investigate the factors influencing the exacerbation of acquired immunodeficiency syndrome (AIDS) patients complicated with carinii pneumocystis pneumonia(PCP).

Methods

From January 2009 to September 2017, data of 1 001 AIDS patients complicated with PCP admitted to Beijing Ditan Hospital, Capital Medical University were collected and analyzed. Patients were divided into 543 patients as mild group (PaO₂ ≥ 70 mmHg) and 458 patients as moderate-to-severe group (PaO₂ < 70 mmHg) according to the level of PaO₂. Univariate and multivariate Logistic regression methods were used to analyze whether factors such as age, increased LDH level, mixed pulmonary infection, hypoproteinemia and pneumothorax affected the disease progress of AIDS patients complicated with PCP.

Results

The incidence of pneumothorax in mild group and moderate-to-severe group were 1.1% (6/543) and 7.6% (35/458), respectively, with significant difference (χ² = 27.027, P < 0.001). The incidence of mixed pathogens in lungs of patients in mild group and moderate-to-severe group were 86.4% (469/543) and 95.0% (435/458), respectively, with significant difference (χ² = 21.027, P < 0.001). The incidence of hypoproteinemia in mild group and moderate-to-severe group were 29.47% (160/543) and 42.58% (195/458), respectively, with significant difference (χ² = 18.658, P < 0.001). In mild group, 174 patients (32.04%) had LDH ≥ 350 U/L, and 282 patients (61.57%) with LDH ≥ 350 U/L in moderate-to-severity group, with no significant difference (χ² = 87.338, P < 0.001). Univariate regression analysis showed that age ≥ 50 years old (OR = 0.489, 95%CI: 0.354-0.676, P < 0.001), LDH ≥ 350 U/L (OR = 0.294, 95%CI: 0.227-0.382, P < 0.001), mixed pulmonary infection (OR = 0.335, 95%CI: 0.206-0.545, P < 0.001), hypoproteinemia (OR = 0.563, 95%CI: 0.434-0.732, P < 0.001) and pneumothorax (OR = 0.135, 95%CI: 0.056-0.324, P < 0.001) were significantly different between the two groups. Multivariate Logistic regression analysis showed that the independent risk factors causing aggravation were age ≥ 50 years old (OR = 0.410, 95%CI: 0.288-0.582, P < 0.001), mixed pulmonary infection (OR = 0.417, 95%CI: 0.251-0.692, P < 0.001), LDH ≥ 350 U/L (OR = 0.298, 95%CI: 0.227-0.392, P < 0.001), hypoproteinemia (OR = 0.685, 95%CI: 0.516-0.908, P = 0.009), and pneumothorax (OR = 0.172, 95%CI: 0.070-0.424, P < 0.001).

Conclusions

Risk factors such as age ≥ 50 years old, mixed pulmonary infection, high LDH level (≥ 350 U/L), hypoproteinemia and pneumothorax could lead to aggravation of disease of patients with AIDS complicated with PCP. The clinical intervention of relevant risk factors could slow down the progress of disease.

Key words: Acquired immnunodeficiency syndrome, Pneumocystis carinii pneumonia, Influence factor

Xiaoli Pang, Zhe Zhang, Jiang Xiao, Yongqin Zeng, Lina Fan, Di Wang, Bei Li, Dan Huang, Junyan Han, Yu Hao, Hongxin Zhao. Influencing factors on the progression of acquired immunodeficiency syndrome patients with Pneumocystis carinii pneumonia[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2019, 13(05): 396-401.

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References 28

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基本资料		轻度PCP组（543例）	中重度PCP组（458例）	χ²值	P值
年龄（岁）		?	?	19.210	< 0.001
?	< 50	468（86.19）	345（75.33）	?	?
?	≥ 50	75（13.81）	113（24.67）	?	?
性别		?	?	0.282	0.595
?	男	499（91.90）	42（92.80）	?	?
?	女	44（8.10）	33（7.20）	?	?
HAART治疗		?	?	0.109	0.742
?	是	58（10.70）	46（10.00）	?	?
?	否	485（89.30）	41（90.00）	?	?
肺部混合感染		?	?	21.027	< 0.001
?	有	469（86.40）	435（95.00）	?	?
?	无	74（13.63）	23（5.02）	?	?
气胸		?	?	27.027	< 0.001
?	有	6（1.10）	35（7.60）	?	?
?	无	537（98.90）	423（92.36）	?	?
肿瘤		?	?	0.064	0.800
?	有	14（2.60）	13（2.84）	?	?
?	无	529（97.42）	445（97.16）	?	?

基本资料		轻度PCP组（543例）	中重度PCP组（458例）	χ²值	P值
年龄（岁）		?	?	19.210	< 0.001
?	< 50	468（86.19）	345（75.33）	?	?
?	≥ 50	75（13.81）	113（24.67）	?	?
性别		?	?	0.282	0.595
?	男	499（91.90）	42（92.80）	?	?
?	女	44（8.10）	33（7.20）	?	?
HAART治疗		?	?	0.109	0.742
?	是	58（10.70）	46（10.00）	?	?
?	否	485（89.30）	41（90.00）	?	?
肺部混合感染		?	?	21.027	< 0.001
?	有	469（86.40）	435（95.00）	?	?
?	无	74（13.63）	23（5.02）	?	?
气胸		?	?	27.027	< 0.001
?	有	6（1.10）	35（7.60）	?	?
?	无	537（98.90）	423（92.36）	?	?
肿瘤		?	?	0.064	0.800
?	有	14（2.60）	13（2.84）	?	?
?	无	529（97.42）	445（97.16）	?	?

体征和指标	轻度PCP组（543例）	中重度PCP组（458例）	统计量	P值
T（℃）^a	37.00（36.00，37.00）	37.10（36.60，38.00）	Z =－3.990	< 0.001
R（次/min）^a	22.00（20.00，24.00）	24.00（22.00，28.00）	Z =－8.989	< 0.001
HR（次/ min）^a	95.00（86.00，108.00）	104.00（90.00，120.00）	Z =－6.971	< 0.001
CRP（mg/L）^a	17.65（5.00，47.00）	54.90（18.95，113.29）	Z =－0.610	0.768
ESR（mm/h）^a	62.00（38.00，79.00）	67.00（46.00，84.00）	Z =－0.092	0.134
低蛋白血症[例（%）]	160（29.47）	195（42.58）	χ² = 18.658	< 0.001
LDH ≥ 350 U/L [例（%）]	174（32.04）	282（61.57）	χ² = 87.338	< 0.001
CD4⁺ T≤ 200 cells/μl [例（%）]	541（99.63）	455（99.34）	χ² = 0.036	0.848

体征和指标	轻度PCP组（543例）	中重度PCP组（458例）	统计量	P值
T（℃）^a	37.00（36.00，37.00）	37.10（36.60，38.00）	Z =－3.990	< 0.001
R（次/min）^a	22.00（20.00，24.00）	24.00（22.00，28.00）	Z =－8.989	< 0.001
HR（次/ min）^a	95.00（86.00，108.00）	104.00（90.00，120.00）	Z =－6.971	< 0.001
CRP（mg/L）^a	17.65（5.00，47.00）	54.90（18.95，113.29）	Z =－0.610	0.768
ESR（mm/h）^a	62.00（38.00，79.00）	67.00（46.00，84.00）	Z =－0.092	0.134
低蛋白血症[例（%）]	160（29.47）	195（42.58）	χ² = 18.658	< 0.001
LDH ≥ 350 U/L [例（%）]	174（32.04）	282（61.57）	χ² = 87.338	< 0.001
CD4⁺ T≤ 200 cells/μl [例（%）]	541（99.63）	455（99.34）	χ² = 0.036	0.848

肺部感染类型	轻度PCP组（543例）	中重度PCP组（458例）	χ²值	P值
PCP +细菌性肺炎	177（32.60）	161（35.20）	0.726	0.394
PCP + CMV肺炎	16（2.90）	8（1.70）	1.528	0.216
PCP +肺结核	16（2.90）	1（0.20）	11.077	0.001
PCP +真菌性肺炎	7（1.29）	3（0.66）	0.471	0.493
≥ 2种其他混合感染类型肺炎	253（46.60）	262（5.70）	11.201	0.001
合计	469（86.37）	435（94.98）	21.027	< 0.001

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