Chest Infections: Atypical Chest Infections |

Outcomes in HIV-Positive vs HIV-Negative Patients With Pneumocystis Jiroveci Pneumonia FREE TO VIEW

Mohleen Kang, MD; Chidinma Ezeonu, MD; Narjust Duma, MD; Yulanka Castro Dominguez, MD; Mirela Feurdean, MD
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Rutgers New Jersey Medical School, Newark, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):110A. doi:10.1016/j.chest.2016.08.119
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SESSION TITLE: Atypical Chest Infections

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 01:30 PM - 03:00 PM

PURPOSE: Along with the recent increase in immunosuppressive therapy for rheumatologic diseases and organ transplant recipients, the incidence of Pneumocystis jiroveci pneumonia (PCP) in HIV negative patients has risen steadily. The goal of this study is to assess outcomes in HIV negative and HIV positive patients with PCP.

METHODS: The National Inpatient Sample database was used to identify patients who were admitted with the diagnosis of PCP in 2013 in the United States. A total of 2,110 patients were studied. For these patients, demographic data (age, sex and race), comorbidities, HIV status, mechanical ventilation requirements and length of in-hospital stay (LOS) were analyzed. The Comorbidity Index was calculated using the Deyo modification of Charlson Comorbidity Index (CCI). Primary endpoint was in-hospital mortality. Clinical differences between HIV negative and HIV positive patients were assessed using the chi-square test for nominal categorical variables and Mann-Whitney U test for ordinal variables and t-test for means. The impact of variables on mortality was assessed using binary logistic regression.

RESULTS: Of the studied population, 73.7% (1556) patients were HIV positive. 65.5% (1382) were males and 37.9% (800) whites. When compared to HIV positive patients, HIV negative patients were older (62 ±16 vs. 43 ±11 years, p <0.001), had more comorbidities (1.52 vs. 0.73, p <0.001) and had longer length of stay (14 ±13 vs. 11 ±11 days, p<0.001). HIV negative patients were more likely to require mechanical ventilation 26% (144) vs. 15.7% (244) of HIV positive patients (p <0.001). Overall, mortality was 12.4% for all patients with PCP. On multivariate analysis, HIV negative patients were twice as likely to have died compared to HIV positive patients (p <0.001). HIV negative patients were more likely to require mechanical ventilation: 26% vs. 15.7% of HIV positive patients (p <0.001). However, there was no significant difference in mortality between HIV negative and HIV positive patients requiring mechanical ventilation (p 0.548) In HIV negative patients, LOS > 8 days (OR: 2.19 95% CI 1.89 - 2.72 p <0.0001) and age >65 years (OR: 2.60 95% CI: 1.78-2.92 p <0.009) were independent predictors of mortality by univariate analysis.

CONCLUSIONS: Among patients with PCP, HIV negative patients have higher mortality compared to HIV positive patients.

CLINICAL IMPLICATIONS: Based on these results, HIV negative patients with PCP should be grouped as having high risk for respiratory failure and mortality, and as such they may benefit from aggressive interventions early in the course of the disease. Further research is needed to identify specific factors that may account for the higher mortality seen in HIV negative patients.

DISCLOSURE: The following authors have nothing to disclose: Mohleen Kang, Chidinma Ezeonu, Narjust Duma, Yulanka Castro Dominguez, Mirela Feurdean

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