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1996-03-09
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Document 0450
DOCN M9650450
TI Predicting in-hospital outcome in HIV-associated Pneumocystis carinii
pneumonia.
DT 9605
AU Bauer T; Ewig S; Hasper E; Rockstroh JK; Luderitz B;
Berufsgenossenschaftliche Kliniken Bergmannsheil, Abt. f.; Pneumologie
u. Allergologie, Bochum, Germany.
SO Infection. 1995 Sep-Oct;23(5):272-7. Unique Identifier : AIDSLINE
MED/96128586
AB Pneumocystis carinii pneumonia (PCP) in HIV-infected patients remains a
life-threatening complication in the course of HIV infection. Despite
effective treatment, mortality may still be as high as 10%. The
identification of risk factors associated with a lethal outcome might be
helpful as a guide to therapy for patients at risk and in the evaluation
of new drugs with anti-pneumocystic activity. In a retrospective study
58 first episodes of HIV-associated PCP without prophylaxis were
analyzed. Variables associated univariately with higher mortality were
identified. A prognostic rule was established in a multivariate approach
using canonical discriminant analysis. Cut-off values for parameters
included were determined in order to allow a clinically applicable
estimate of the individual risk. Variables associated with early
mortality were hemoglobin, hematocrit, platelet count, albumin, total
protein, gamma-globulins, and AaDO2. LDH values, percentage of
neutrophils in the BAL, as well as the cellular immunologic state as
indicated by CD4-cell count were not significantly associated with the
outcome. The discriminant function yielded the best classification
results with the inclusion of hemoglobin, albumin, and gamma-globulins
(overall accuracy 86%). Two or more of the following parameters were
associated with a 14-fold increased risk of in-hospital mortality:
hemoglobin less than 10 g/dl, albumin less than 3 g/dl, and
gamma-globulins less than 1.2 g/dl. This prognostic rule was 80%
sensitive and 94% specific with a negative predictive value of 94%,
yielding an overall accuracy of 91%. Patients with HIV-associated PCP
with a positive prognostic rule have a 14-fold increased risk for
in-hospital lethal outcome. This discriminant rule may be helpful in
identifying patients at risk.
DE Adult AIDS-Related Opportunistic Infections/DRUG THERAPY/*MORTALITY/
PHYSIOPATHOLOGY Bacterial Infections/COMPLICATIONS Bronchoalveolar
Lavage Candidiasis/COMPLICATIONS Female Hospitals Human Leukocyte
Count Male Multivariate Analysis *Outcome Assessment (Health Care)
Pneumonia, Pneumocystis carinii/COMPLICATIONS/DRUG THERAPY/
*MORTALITY/PHYSIOPATHOLOGY Retrospective Studies Risk Factors JOURNAL
ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).