Lower Mortality Associated With Adjuvant Corticosteroid Therapy in Non-HIV-Infected Patients With Pneumocystis jirovecii Pneumonia: A Single-Institution Retrospective US Cohort Study

William Mundo, Louis Morales-Shnaider, Selam Tewahade, Eric Wagner, Solana Archuleta, Mohamed Bandali, Sindhu Chadalawada, Steven C Johnson, Carlos Franco-Paredes, Leland Shapiro, Andrés F Henao-Martínez, William Mundo, Louis Morales-Shnaider, Selam Tewahade, Eric Wagner, Solana Archuleta, Mohamed Bandali, Sindhu Chadalawada, Steven C Johnson, Carlos Franco-Paredes, Leland Shapiro, Andrés F Henao-Martínez

Abstract

Background: Pneumocystis jirovecii pneumonia (PJP) remains a cause of mortality in HIV-negative patients. The clinical benefit of adjuvant corticosteroids in these patients is uncertain. This study aimed to determine if corticosteroids would reduce mortality in a cohort of HIV-negative PJP patients.

Methods: We examined a retrospective case series of patients diagnosed with PJP at the University of Colorado Hospital between 1995 and 2019. Data were collected in 71 PJP-infected patients. Twenty-eight patients were HIV-negative, and 43 were infected with HIV. We performed bivariate and forward, stepwise multivariable logistic regressions to identify mortality predictors.

Results: Common underlying conditions in HIV-negative patients were hematologic malignancies (28.6%), autoimmune disorders (25.9%), and solid organ transplantation (10.7%). HIV-negative patients had higher rates and durations of mechanical ventilation and intensive care unit stay. Survival was significantly increased in HIV-negative patients receiving adjuvant corticosteroids, with 100% mortality in patients not receiving corticosteroids vs 60% mortality in patients receiving corticosteroids (P = .034). In an adjusted multivariable model, no adjuvant corticosteroid use was associated with higher mortality (odds ratio, 13.5; 95% CI, 1.1-158.5; P = .039) regardless of HIV status.

Conclusions: We found substantial mortality among HIV-negative patients with PJP, and adjuvant corticosteroid use was associated with decreased mortality. Response to corticosteroids is best established in HIV-infected patients, but emerging reports suggest a similar beneficial response in PJP patients without HIV infection. Further prospective studies may establish a more definitive role of the addition of corticosteroids among HIV-negative patients with PJP.

Keywords: HIV negative; Pneumocystis jirovecii pneumonia; prognosis; retrospective corticosteroid adjuvant therapy.

© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Figures

Figure 1.
Figure 1.
Survival curves based on HIV status in patients with Pneumocystis jirovecii pneumonia.
Figure 2.
Figure 2.
Mortality differences by HIV status and use of steroids in Pneumocystis jirovecii pneumonia. *P ≤ .05. Abbreviation: PJP, Pneumocystis jirovecii pneumonia.

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Source: PubMed

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