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Determinants of Short- and Long-term Outcome in Patients With Respiratory Failure Caused by AIDS-Related Pneumocystis carinii Pneumonia
David M. Forrest, MD, MHSc, FRCPC;
Carlos Zala, MD;
Ognjenka Djurdjev, MSc;
Joel Singer, PhD;
Kevin J. P. Craib, MMath;
Lindsay Lawson, MD, FRCPC;
James A. Russell, MD, FRCPC, FCCP;
Julio S. G. Montaner, MD, FRCPC, FCCP
Arch Intern Med. 1999;159:741-747.
Objectives To determine (1) predictors of in-hospital mortality and long-term survival in patients with acute respiratory failure (ARF) caused by acquired immunodeficiency syndrome–related Pneumocystis carinii pneumonia (PCP) and (2) long-term survival for patients with ARF relative to those without ARF.
Methods A retrospective medical chart review was conducted of all cases of PCP-related ARF for which the patient was admitted to the intensive care unit of a single tertiary care institution between 1991 and 1996. Data were extracted regarding physiologic scores, relevant laboratory values, and duration of previous maximal therapy with combined anti-PCP agents and corticosteroids at entry to the intensive care unit. Duration of survival was determined by Kaplan-Meier methods from date of first hospital admission and compared for patients with and without ARF.
Results There were 41 admissions to the intensive care unit among 39 patients, with 56.4% in-hospital mortality. Higher physiologic scores (Acute Physiology and Chronic Health Evaluation II [APACHE II], Acute Lung Injury, and modified Multisystem Organ Failure scores) were predictive of in-hospital mortality. Duration of previous maximal therapy also predicted in-hospital mortality (45% for patients with <5 days of previous maximal therapy vs 88% for those with  5 days of previous maximal therapy; P=.03). Combining physiologic scores and duration of previous maximal therapy enhanced prediction of in-hospital mortality. There was no difference in long-term survival between patients with PCP with ARF and those without ARF (P=.80), and baseline characteristics did not predict long-term survival.
Conclusions In-hospital mortality of patients with acquired immunodeficiency syndrome–related PCP and ARF is predicted by duration of previous maximal therapy and physiologic scores, and their combination enhances predictive accuracy. Long-term survival of patients with ARF caused by PCP is comparable to that of patients with PCP who do not develop ARF, and determinants of in-hospital mortality do not predict long-term survival.
From the British Columbia Center for Excellence in HIV/AIDS (Drs Forrest, Zala, and Montaner and Mr Craib) and the Departments of Health Care and Epidemiology (Dr Singer and Mr Craib) and Medicine (Drs Lawson, Russell, and Montaner), St Paul's Hospital; the Divisions of Critical Care Medicine (Drs Forrest and Russell) and Respiratory Medicine (Dr Lawson) and the Faculty of Medicine (Drs Lawson, Russell, and Montaner), University of British Columbia; and the Canadian HIV Trials Network (Ms Djurdjev and Drs Singer and Montaner), Vancouver, British Columbia.
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