Previous corticosteroid exposure associates with an increased Pneumocystis jirovecii pneumonia mortality among HIV-negative patients: a global research network with a follow-up multicenter case-control study
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Título: | Previous corticosteroid exposure associates with an increased Pneumocystis jirovecii pneumonia mortality among HIV-negative patients: a global research network with a follow-up multicenter case-control study |
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Autor/es: | Vargas Barahona, Lilian | Molina, Kyle C. | Pedraza-Arévalo, Laura C. | Sillau, Stefan | Tagawa, Alex | Scherger, Sias | Chastain, Daniel B. | Shapiro, Leland | Tuells, José | Franco-Paredes, Carlos | Hawkins, Kellie L. | Maloney, James P. | Thompson III, George R. | Henao-Martinez, Andres F. |
Grupo/s de investigación o GITE: | Salud Comunitaria (SALUD) |
Centro, Departamento o Servicio: | Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia |
Palabras clave: | Corticosteroids | HIV-negative patients | Immunocompetent | Mortality | Pneumocystis carinii | Pneumocystis jirovecii |
Fecha de publicación: | 14-mar-2023 |
Editor: | SAGE Publications |
Cita bibliográfica: | Therapeutic Advances in Infectious Disease. 2023, 10: 1-13. https://doi.org/10.1177/20499361231159481 |
Resumen: | Background: HIV-negative patients have substantial mortality from Pneumocystis jirovecii pneumonia (PJP). We lack predictors of HIV-negative PJP-associated mortality. Objective: We aim to characterize the role of prior corticosteroid exposure in PJP-related mortality. Methods: We queried a global research network to identify adult HIV-negative patients with PJP with or without corticosteroid exposure in the preceding year before diagnosis (n = 8,021). We performed a propensity score-matched analysis to adjust baseline patient characteristics and analyzed outcomes. We follow-up the results with a multicenter ten years retrospective case-control cohort of HIV-negative patients tested for PJP by PCP Direct Fluorescent Antigen. We used a Cox proportional hazards model for survival analysis. Results: 1822 HIV-negative propensity-scored matched patients with prior corticosteroid exposure had significantly increased 10 weeks (16% versus 9%, p < 0.0001) and one-year mortality after PJP diagnosis (23% versus 14%, p < 0.0001). (1→3)-β-D-glucan (197.6 ± 155.8 versus 63 ± 0 pg/ml, p = 0.014), ferritin levels (1227 ± 2486 versus 768 ± 1060 mcg/l, p = 0.047), lymphopenia (1.5 ± 1.5 versus 2.0 ± 1.6 103 cells/µl, p < 0.0001) and hypoxia (SatO2: 86.7% versus 91.6%, p < 0.0001) were higher or worse in those with prior steroid use. Patients who died were more likely to have previously received dexamethasone (35% versus 16%, p < 0.001) or prednisone (49% versus 29%, p < 0.001). Adjusted Cox proportional-hazard model validation showed an independently increased mortality at 10 weeks (HR: 3.7, CI: 1.5–9.2, p = 0.004) and 1 year (HR: 4.5, CI: 2.0–10.4, p < 0.0001) among HIV-negative patients with previous corticosteroid exposure. Conclusion: Preceding corticosteroids in HIV-negative patients with PJP are associated with higher mortality. A higher fungal burden may influence corticosteroid-mediated mortality. Assessment of PJP prophylaxis must become a standard clinical best practice when instituting corticosteroid therapy courses. |
URI: | http://hdl.handle.net/10045/132946 |
ISSN: | 2049-9361 (Print) | 2049-937X (Online) |
DOI: | 10.1177/20499361231159481 |
Idioma: | eng |
Tipo: | info:eu-repo/semantics/article |
Derechos: | © The Author(s), 2023. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
Revisión científica: | si |
Versión del editor: | https://doi.org/10.1177/20499361231159481 |
Aparece en las colecciones: | INV - SALUD - Artículos de Revistas |
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