Characteristics and Prognosis Factors of Pneumocystis jirovecii Pneumonia According to Underlying Disease

Romain Lécuyer (1, 2) , Nahéma Issa (3, 4) , Fabrice Camou (3, 4) , Rose-Anne Lavergne (2) , Frederic Gabriel (5) , Florent Morio (6, 2) , Emmanuel Canet (7) , François Raffi (8) , David Boutoille (7, 8) , Anne Cady (1) , Marie Gousseff (1) , Yoann Crabol (1) , Antoine Néel (9, 10, 11) , Benoît Tessoulin (12, 13) , Benjamin Gaborit (8, 10)

1 CHBA - Centre hospitalier Bretagne Atlantique (Morbihan)
2 IICiMed - Cibles et Médicaments des Infections et de l'Immunité
3 Hôpital Saint-André
4 UB - Université de Bordeaux
5 CHU de Bordeaux - Centre Hospitalier Universitaire de Bordeaux
6 Départements de Dermatologie, Parasitologie, Mycologie, Mycologie [Atlanpole, Nantes]
7 Service des maladies infectieuses et tropicales [CHU Nantes]
8 CIC Nantes - Centre d’Investigation Clinique de Nantes
9 CHU Nantes - Centre Hospitalier Universitaire de Nantes
10 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
11 Team 4 - U1064 Inserm - CR2TI - Team 4 : Deciphering organ immune regulation in inflammation and transplantation (DORI-t)
12 Service d'Hématologie [CHU Nantes]
13 CRCI2NA - Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes-Angers

Background: Pnemocystis 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 question: Does the underlying disease and immunosuppression causing PcP impact the outcome and clinical presentation of the disease? Study design and methods: In 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. Results: Overall, 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). Interpretation: Among 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.

Mots clés: Pneumocystis jirovecii pneumonia; corticosteroids; immune-mediated inflammatory diseases; outcome; solid tumors

Domaines: Sciences du Vivant [q-bio]

Romain Lécuyer, Nahéma Issa, Fabrice Camou, Rose-Anne Lavergne, Frederic Gabriel, et al.. Characteristics and Prognosis Factors of Pneumocystis jirovecii Pneumonia According to Underlying Disease. Chest, 2024, pp.S0012-3692(24)00022-9. ⟨10.1016/j.chest.2024.01.015⟩. ⟨inserm-04446239⟩