EMPIRICALLY TREATED PNEUMOCYSTIS-CARINII PNEUMONIA IN LONDON, 1983-1989

被引:14
作者
BECK, EJ
FRENCH, PD
HELBERT, MH
ROBINSON, DS
MOSS, FM
HARRIS, JRW
PINCHING, AJ
MITCHELL, DM
机构
[1] Academic Department of Public Health, St Mary's Hospital Medical School, London W2 1PG, Norfolk Place
关键词
PNEUMOCYSTIS-CARINII PNEUMONIA; EMPIRICAL DIAGNOSIS; AIDS; EPISODE OUTCOME; MORTALITY PATTERNS;
D O I
10.1177/095646249200300411
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
For 227 episodes of Pneumocystis carinii pneumonia (PCP) treated at St Mary's between 1983 and 1989, factors predictive of fatal outcome were age, haemoglobin levels, peripheral lymphocyte count and alveolar-arterial oxygen gradient. Case fatality for the 47 empirically-treated episodes was significantly higher compared with the 180 cytologically proven episodes (55% vs 18%, chi-2 = 25.7, P < 0.0001). Case fatality for episodes which could not be bronchoscoped was significantly higher compared with bronchoscopy negative cases (66% vs 25%, chi-2 = 4.5, P<0.05). Predictive factors for fatal outcome differed significantly for cases which could not be bronchoscoped and cytologically proven cases: haemoglobin level (10.7g/dl vs 12.0g/dl, P<0.001), lymphocyte count (0.64 x 10(9)/l vs 0.87 x 10(9)/l, P = 0.05) and oxygen gradient (77.7 mmHg vs 58.9 mmHg, P < 0.02). Such differences were not observed between bronchoscopy negative and cytologically proven cases. Case fatality decreased significantly over time (b = - 0.39, SE = 0. 14, P < 0.05). Total and non-fatal first time episodes displayed an inverse relationship between oxygen gradient and time (r = -0.22, P < 0.006 and r = -0.24, P < 0.01, respectively). Mean oxygen gradient of fatal episodes for sequential years increased significantly from 73 mmHg in 1983 to 102 mmHg in 1989 (r = 0.92, P < 0.01). This suggests that medical intervention as well as presentation with less severe disease both contributed to improved case fatality over time.
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页码:285 / 287
页数:3
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