• Romain Lécuyer, Nahéma Issa, Fabrice Camou, Rose-Anne Lavergne, Frederic Gabriel, Florent Morio, Emmanuel Canet, François Raffi, David Boutoille, Anne Cady, Marie Gousseff, Yoann Crabol, Antoine Néel, Benoît Tessoulin, Benjamin Gaborit, and PRONOCYSTIS Study Group.
• Internal Medicine and Infectious Diseases, Centre Hospitalier Bretagne-Atlantique, Vannes, France; Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, UR1155, Nantes, France.
• Chest. 2024 Jun 1; 165 (6): 131913291319-1329.

BackgroundPneumocystis jirovecii pneumonia (PcP) remains associated with high rates of mortality, and the impact of immunocompromising underlying disease on the clinical presentation, severity, and mortality of PcP has not been adequately evaluated.Research QuestionDoes the underlying disease and immunosuppression causing PcP impact the outcome and clinical presentation of the disease?Study Design And MethodsIn this multicenter retrospective observational study, conducted from January 2011 to December 2021, all consecutive patients admitted with a proven or probable diagnosis of PcP according to the European Organisation for Research and Treatment of Cancer consensus definitions were included to assess the epidemiology and impact of underlying immunosuppressive diseases on overall and 90-day mortality.ResultsOverall, 481 patients were included in the study; 180 (37.4%) were defined as proven PcP and 301 (62.6%) were defined as probable PcP. Patients with immune-mediated inflammatory diseases (IMIDs) or solid tumors had a statistically poorer prognosis than other patients with PcP at day 90. In multivariate analysis, among the HIV-negative population, solid tumor underlying disease (OR, 5.47; 95% CI, 2.16-14.1; P < .001), IMIDs (OR, 2.19; 95% CI, 1.05-4.60; P = .037), long-term corticosteroid exposure (OR, 2.07; 95% CI, 1.03-4.31; P = .045), cysts in sputum/BAL smears (OR, 1.92; 95% CI, 1.02-3.62; P = .043), and SOFA score at admission (OR, 1.58; 95% CI, 1.39-1.82; P < .001) were independently associated with 90-day mortality. Prior corticotherapy was the only immunosuppressant associated with 90-day mortality (OR, 1.67; 95% CI, 1.03-2.71; P = .035), especially for a prednisone daily dose ≥ 10 mg (OR, 1.80; 95% CI, 1.14-2.85; P = .010).InterpretationAmong patients who were HIV-negative, long-term corticosteroid prior to PcP diagnosis was independently associated with increased 90-day mortality, specifically in patients with IMIDs. These results highlight both the needs for PcP prophylaxis in patients with IMIDs and to early consider PcP curative treatment in severe pneumonia among patients with IMIDs.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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