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Prognostic Indicators of Acute Mortality due to Pneumocystis carinii Pneumonia Associated With the Acquired Immunodeficiency Syndrome

Jeffrey C. Fried, MD; Jonathan S. LoPresti, MD, PhD; Monica Micon, MD; Madeline Bauer, PhD; James A. Tuchschmidt, MD; John T. Nicoloff, MD

Arch Intern Med. 1990;150(2):406-409.

Abstract
• A feasibility study was undertaken prospectively to identify early clinical and laboratory factors predictive of acute hospital mortality in patients with the acquired immunodeficiency syndrome and concurrent Pneumocystis carinii pneumonia. Twentysix patients hospitalized with bronchoscopy-proved P carinii pneumonia were studied. Nineteen patients survived their episode of P carinii pneumonia, while 7 subjects did not. The only clinical factor associated with mortality was a history of a shorter duration of pulmonary symptoms. Univariate analysis showed decreased total CD8 cell count, total lymphocyte count, serum hemoglobin, serum albumin, total thyroxine, and total triiodothyronine values consistent with a poor outcome. Multivariate logistic regression analysis showed that the single best prognostic indicator of acute mortality appeared to be a total serum triiodothyronine value less than 0.70 nmol/L obtained early in the hospital course, and that the combination of serum triiodothyronine and hemoglobin values provided a better indication for survival. These preliminary observations would appear to justify the further exploration of serial serum triiodothyronine measurements as a potentially valuable prognostic indicator for the treatment of patients with acquired immunodeficiency syndrome infected with P carinii and possibly other intercurrent infectious illnesses.

(Arch Intern Med. 1990;150:406-409)

Author Affiliations
From the Sections of Pulmonary/Critical Care Medicine (Drs Fried and Tuchschmidt) and Endocrinology (Drs LoPresti and Nicoloff), Department of Medicine; the Department of Radiology (Dr Micon); and Clinical Research Center (Dr Bauer), University of Southern California School of Medicine, Los Angeles.

Footnotes
Accepted for publication September 1,1989.

Reprint requests to Department of Internal Medicine, University of Southern California School of Medicine, 2025 Zonal Ave, Los Angeles, CA 90033 (Dr LoPresti).

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