Impact of Pneumocystis Pneumonia on Non-HIV Immunocompromised Patient Outcomes

Abstract Backgrounds Pneumocystis pneumonia (PCP) remains an important cause of morbidity and mortality in non-HIV immunocompromised patients especially solid organ transplant（SOT）recipients. There is a lack of data on the effects of PCP on the outcomes of them. Method We retrospectively analyzed the clinical data of 34 non-HIV immunocompromised patients who were diagnosed with PJP by metagenomic next-generation sequencing(mNGS) combined with clinical symptoms and CT imaging changes admitted to our hospital from October 2018 to December 2020. We use univariable analysis and multi-logistic regression analysis to screen the main risk factors that affect the prognosis. Results A total of 65 patients found Pneumocystis jiroveci through mNGS from the BALF. Among them 34 non-HIV immunocompromised patients who were diagnosed with PCP were included. The mortality rate was 41.2%. Among them, 19 were kidney recipients, 1 liver recipient, 5 cases of connective tissue disease，4 cases of blood system diseases, 5 cases of others (including tumors and skin diseases). The ICU occupancy rate was 85.3%. The univariable analysis between the two groups found that the main risk factors affecting the outcome included age, body mass index (BMI), albumin (ALB), SOFA score on the first day of entering the ICU, the interval time between symptom onset and the start of TMP/SMX treatment, and invasive mechanical ventilation. However, patients who accepted early combination seems to get better outcome. Conclusion Old age, low BMI, hypoalbuminemia, mechanical ventilation, and delayed treatment may be associated with a worse outcome. Early diagnosis and treatment are key factors to improve the outcome of PCP. We should actively correct the malnutrition condition, and give early combination of TMP/SMX and echinocandin therapy may improve the prognosis.