Walzer et al identified factors associated with increased mortality in HIV-infected patients with Pneumocystis jirovecii (nee P. carinii) pneumonia (PCP). Most of the predictors will be available at the time of hospital admission. The authors are from the London School of Hygiene and Tropical Medicine, University College London, Camden Primary Care Trust, and the University of Cincinnati
NOTE: The patients were not taking HAART prior to presentation with PCP.
Predictors of mortality:
(1) increasing patient age
(2) previous episode of PCP
(3) low hemoglobin at the time of hospital admission
(4) low PaO2 while breathing room air at the time of hospital admission
(5) significant medical comorbidity
(6) pulmonary Kaposi sarcoma
|
Predictor |
Finding |
Points |
|
age |
< 50 years |
0 |
|
|
>= 50 years |
1 |
|
episode of PCP |
first |
0 |
|
|
second or third |
1 |
|
hemoglobin |
>= 12 g/dL |
0 |
|
|
< 12 g/dL |
1 |
|
PaO2 on room air |
>= 8.0 kPa |
0 |
|
|
< 8.0 kPa (< 60 mm Hg) |
1 |
|
medical comorbidity |
none |
0 |
|
|
1 or more |
1 |
|
pulmonary Kaposi sarcoma |
absent |
0 |
|
|
present |
1 |
where:
• The patient may be sicker during a first episode, but the risk is greater with subsequent episodes (probably reflecting longer duration of AIDS).
• The patients presumably have AIDS.
total number of predictors =
= SUM(points for all 6 predictors)
Interpretation:
• minimum total: 0
• maximum total: 6
• The more predictors that are present the greater the risk of mortality. The mortality rate from 1996 to 2006 was about 10%.
Purpose: To identify risk factors for hospital mortality for an HIV-infected patient admitted for Pneumocystis jirovecii pneumonia as reported by Walzer et al.
Specialty: Infectious Diseases
Objective: severity, prognosis, stage, comorbid conditions
ICD-10: B20,
