The prognosis in patients with HIV infection and Pneumocystis carinii pneumonia can be estimated from a prognostic severity score. Early identification of patients with a poor prognosis can allow for either more aggressive therapy or use of innovative strategies.
Parameters:
(1) alveolar-arterial oxygen tension difference in mm Hg on room air (FIO2 21%)
(2) serum LDH as multiple of upper limit to the reference range
(3) percent neutrophils in the broncho-alveolar lavage (BAL)
|
Parameter |
Finding |
Points |
|
alveolar-arterial oxygen tension difference in mm Hg, P(A-a)O2 |
<= 20 |
0 |
|
|
21 - 30 |
1 |
|
|
31 - 40 |
2 |
|
|
41 - 50 |
3 |
|
|
51 - 60 |
4 |
|
|
> 60 |
5 |
|
LDH |
normal |
0 |
|
|
> normal to 2 * (normal) |
1 |
|
|
> 2 * (normal) to 3 * (normal) |
2 |
|
|
> 3 * (normal) |
3 |
|
percent neutrophils in broncho-alveolar lavage (BAL) |
<= 2% |
0 |
|
|
3 - 5% |
1 |
|
|
6 - 10% |
2 |
|
|
11 - 15% |
3 |
|
|
16 - 20% |
4 |
|
|
> 20% |
5 |
where:
• The alveolar oxygen tension can be estimated from the percent inspired oxygen and PaCO2 by the following equation as described in the Pulmonary chapter:
PAO2 = (7 * (FIO2 as number from 21 to 100)) - (1.25 * (PaCO2 in mm Hg))
PCP severity score =
= (points for oxygen difference) + (points for LDH) + (points for percent neutrophils)
Interpretation:
• minimum score: 0
• maximum score: 13
• Outcome is death within 14 days after bronchoscopy or survival.
|
PCP severity score |
survival |
death |
|
< 7 |
100% |
0% |
|
7 |
33% |
67% |
|
> 7 |
0% |
100% |
Specialty: Infectious Diseases
ICD-10: ,
