To examine outcome and associated factors of acute respiratory failure (ARF) secondary to non-HIV-related PCP in patients admitted to the intensive care unit (ICU) between 1995 and 2001.
A retrospective review of medical charts and APACHE III database. Data abstracted included patients’ demographics, length of stay (LOS), APACHE III score, diagnostic procedures, prophylaxis, medications, ventilator data, discharge location and mortality.
We identified 24 patients (13 female, 11 male) with non-HIV-related PCP and ARF. In-hospital, 6 month and 1 year-mortality rates were 63%, 75% and 78%, respectively. Mean age was 62. Mean APACHE III score was 68. Mean ICU and hospital LOS were 13 and 23 days. Four patients who had pneumothorax died. All but one patient had an elevated LDH with a mean level of 547. Mean glucose level on day one was 140. The diagnosis was made by bronchoalveolar lavage (BAL) in 22 and by transbronchial biopsy in remaining 2 patients. All patients were immunosuppressed (7 had corticosteroids, 6 had chemotherapy and remainder combination of both). Median prednisone-equivalent dose was 45 mg for 5 months. Not a single patient received PCP prophylaxis. 20 patients required invasive positive pressure ventilation (PPV) for a median of 7 days (1-42) and 4 patients required only non-invasive PPV. Mean PaO2/FiO2 ratio was 121 and in all but in one patient this ratio was less than 200. Mean tidal volume (TV) in ml/kg of ideal body weight was 10.4. Hospital mortality was associated with APACHE III score (p=0.04), length of PPV (p=0.016) and glucose level on day one (p=0.018).
Among patients with ARF secondary to non-HIV-related PCP poor prognostic factors include high APACHE III scores, longer duration of PPV and hyperglycemia. All patients in our cohort failed to receive PCP prophylaxis.
ARF secondary to non-HIV-related PCP remains a serious illness with high hospital mortality. Primary PCP prophylaxis should be strongly considered for all non-HIV immunosuppressed patients.
E. Festic, None.