| BackgroundPneumocystis carinii pneumonia(PCP)is a common and life-threatening fungal infection.In the past,PCP was the most common opportunistic infection in AIDS patients.With the highly active antiretroviral therapy and prophylaxis antipneumocystis therapy,the incidence rate of AIDS patients has been reduced significantly.However,with the application of hormones,immunosuppressants,tumor chemoradiotherapy and organ transplantation,the incidence rate of PCP in non-HIV infected population is obviously higher,with a mortality of 30%-50%.Compared with HIV infected PCP patients,non-HIV infected PCP patients have more insidious onset,more rapid progression and higher mortality.P.jirovecii can not grow on culture media in vitro,the gold standard for the diagnosis of PCP is still the discovery of characteristic cysts or trophoblasts by staining microscopic examination of lower respiratory tract specimens.However,the traditional staining microscopy method has a low detection rate and a long cycle,which mainly depends on the level of laboratory physician,and the lower fungal load of non-HIV infected patients.Therefore,the early diagnosis and treatment of such diseases are largely limited,leading to misdiagnosis,missed diagnosis and high mortality.ObjectiveThe purpose of this study is to discuss the general clinical characteristics of non-HIV infected patients with PCP,analyze the relevant factors affecting the prognosis of PCP patients,improve the recognition of PCP disease by clinicians,and predict its prognosis through early test results,so as to reduce misdiagnosis,missed diagnosis and mortality.MethodsA total of 88 non-HIV infected PCP patients admitted to the Intensive Care Unit(ICU)of the First Affiliated Hospital of Zhengzhou University from August 2018 to December 2020 were collected and divided into the survival group(n=38)and the death group(n=50)according to the prognosis of the patients upon discharge.The clinical data of 88 patients with PCP,such as age,gender,underlying diseases,length of hospital stay,treatment history of hormone or immunosuppressive agents,personal history,clinical manifestation,laboratorytest results(blood routine,arterial blood gas analysis,liver and kidney function,inflammatory biomarkers,fungi and microbial cultures,etc.),imaging examination,treatment and co-infection.SPSS 24.0 was used for the statistical analysis.The counting data were described by frequency,and the comparison between groups was conducted by the chi-square test,the adjusted chi-square test,or the Fisher’s exact probability test.The quantitative data conforming to normal distribution and homogeneity of variance were expressed as mean ±standard deviation(x±S),and T test was used for comparison between groups.The quantitative data that did not conform to the normal distribution were represented by M(P25,P75),and the comparison between groups was performed by Mann-whitney U test.The variables with significant differences in univariate analysis were selected to enter the multivariate analysis model,and the risk factors of the disease were analyzed by logistic multiple regression,with P<0.05 as the difference was statistically significant.Results(1)In this study,there were 38 cases in survival group and 50 cases in death group,accounting for 56.8%of all patients.(2)From a basic point of view,the age distribution of this study ranged from 18 to 85 years old,with an average age of 54.7±14.8 years old,and there was no significant difference in gender.The age of death group was significantly higher than that of survival group(P<0.05),the time of ICU stay in death group was significantly lower than that of survival group(P<0.05).In terms of clinical manifestations and signs,cough symptoms in the death group were significantly lower than those in the survival group(P<0.05),and dry and wet rales in the death group were significantly more than those in the survival group(P<0.05).The results of laboratory tests showed that Aspartate aminotransferase(AST),lactate dehydrogenase(LDH)and procalcitonin(PCT)in the death group were significantly higher than those in the survival group(P<0.05),and the oxygenation index(PaO2/FiO2)in the death group was significantly lower than that in the survival group(P<0.05).In terms of diagnosis and treatment,88 patients underwent gomori methenamine silver(GMS)staining,7 of them were positive.mNGS test was performed in 87 patients,and all of them were detected with P jirovecii.The death group received mechanical ventilation significantly higher than the survival group(P<0.05).In terms of co-infection,the death combination combined with Klebsiella pneumoniae was significantly higher than the survival group(P<0.05).(3)Univariate analysis showed that age,duration of ICU stay,cough,rales,high aspertate aminotransferase,high lactate dehydrogenase,high Procalcitonin,low oxygenation index,mechanical ventilation therapy and combined with klebsiella pneumoniae infection were significantly correlated with the mortality(P<0.05).(4)Logistic multivariate regression analysis showed that high Procalcitonin,and mechanical ventilation were independent risk factors affecting the mortality of inpatients.Conclusion(1)High procalcitonin and mechanical ventilation were independent risk factors affecting the mortality of inpatients.(2)Metagenomic next-generation sequencing was significantly better than the traditional gomori methenamine silver staining method in the diagnosis of PCP,and could be used as the main method for the diagnosis of PCP. |
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