伴有肺孢子虫定植的重症肺炎患者的临床特征和预后:一项多中心回顾性研究。

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE Chest Pub Date : 2025-01-01 Epub Date: 2024-07-23 DOI:10.1016/j.chest.2024.07.140
Yongpo Jiang, Xiaohan Huang, Huili Zhou, Mingqiang Wang, Shengfeng Wang, Xindie Ren, Guojun He, Jun Xu, Qianqian Wang, Muhua Dai, Yonghui Xiong, Lin Zhong, Xuwei He, Xuntao Deng, Yujie Pan, Yinghe Xu, Hongliu Cai, Shengwei Jin, Hongyu Wang, Lingtong Huang
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引用次数: 0

摘要

背景:几十年来,重症肺炎患者中若韦氏肺孢子菌(P. jirovecii)定植的发生率和临床特征仍不清楚:研究问题:在确诊为重症肺炎的患者中,与 P. jirovecii 定植相关的临床特征和结果是什么?在这项多中心、回顾性、配对研究中,纳入了2019年至2023年期间在17个医疗中心的重症监护室接受支气管肺泡灌洗临床元基因组学检查的重症肺炎患者。根据临床元基因组学、肺部 CT 扫描和临床表现对患者进行诊断。回顾性收集临床数据,根据倾向得分匹配和Cox多元回归分析,比较了P. jirovecii定植患者与P. jirovecii阴性患者的预后:结果:40%的P. jirovecii阳性患者被认为有P. jirovecii定植。与 P. jiroveci 阴性组相比,P. jirovecii 定植组中免疫抑制患者比例更高,淋巴细胞计数更低。肺部巨细胞病毒、爱泼斯坦-巴尔病毒、人类疱疹病毒-6B、人类疱疹病毒-7 和 torque teno 病毒的检测频率与 P. jirovecii 定植相关,而与 P. jirovecii 阴性相关。通过倾向得分匹配建立两个队列,我们将编码检测到的微生物和临床特征纳入 Cox 比例危险度模型,结果显示,P. jirovecii 定植是重症肺炎患者死亡的独立危险因素。根据敏感性分析(包括或不包括检测到的微生物以及未接受TMP-SMX治疗的患者),也得出了类似的结论:解读:免疫抑制和淋巴细胞计数减少被认为是非肺结核患者感染嗜血杆菌的风险因素。在P. jirovecii定植患者中更频繁地检测到各种病毒,P. jirovecii定植与重症肺炎患者28天死亡率的增加有关。
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Clinical Characteristics and Prognosis of Patients With Severe Pneumonia With Pneumocystis jirovecii Colonization: A Multicenter, Retrospective Study.

Background: For decades, the incidence and clinical characteristics of Pneumocystis jirovecii colonization in patients with severe pneumonia was unclear.

Research question: What are the clinical features and outcomes associated with P jirovecii colonization in individuals diagnosed with severe pneumonia?

Study design and methods: In this multicenter, retrospective, matched study, patients with severe pneumonia who underwent bronchoalveolar lavage clinical metagenomics from 2019 to 2023 in the ICUs of 17 medical centers were enrolled. Patients were diagnosed based on clinical metagenomics, pulmonary CT scans, and clinical presentations. Clinical data were collected retrospectively, and according to propensity score matching and Cox multivariate regression analysis, the prognosis of patients with P jirovecii colonization was compared with that of patients who were P jirovecii-negative.

Results: A total of 40% of P jirovecii-positive patients are considered to have P jirovecii colonization. The P jirovecii colonization group had a higher proportion of patients with immunosuppression and a lower lymphocyte count than the P jirovecii-negative group. More frequent detection of cytomegalovirus, Epstein-Barr virus, human herpesvirus-6B, human herpesvirus-7, and torque teno virus in the lungs was associated with P jirovecii colonization than with P jirovecii negativity. By constructing two cohorts through propensity score matching, we incorporated codetected microorganisms and clinical features into a Cox proportional hazards model and revealed that P jirovecii colonization was an independent risk factor for mortality in patients with severe pneumonia. According to sensitivity analyses, which included or excluded codetected microorganisms, and patients not receiving trimethoprim-sulfamethoxazole treatment, similar conclusions were reached.

Interpretation: Immunosuppression and a reduced lymphocyte count were identified as risk factors for P jirovecii colonization in patients with non-Pneumocystis pneumonia. More frequent detection of various viruses was observed in patients colonized with P jirovecii, and P jirovecii colonization was associated with an increased 28-day mortality in patients with severe pneumonia.

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来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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