Document 0450
 DOCN  M9650450
 TI    Predicting in-hospital outcome in HIV-associated Pneumocystis carinii
       pneumonia.
 DT    9605
 AU    Bauer T; Ewig S; Hasper E; Rockstroh JK; Luderitz B;
       Berufsgenossenschaftliche Kliniken Bergmannsheil, Abt. f.; Pneumologie
       u. Allergologie, Bochum, Germany.
 SO    Infection. 1995 Sep-Oct;23(5):272-7. Unique Identifier : AIDSLINE
       MED/96128586
 AB    Pneumocystis carinii pneumonia (PCP) in HIV-infected patients remains a
       life-threatening complication in the course of HIV infection. Despite
       effective treatment, mortality may still be as high as 10%. The
       identification of risk factors associated with a lethal outcome might be
       helpful as a guide to therapy for patients at risk and in the evaluation
       of new drugs with anti-pneumocystic activity. In a retrospective study
       58 first episodes of HIV-associated PCP without prophylaxis were
       analyzed. Variables associated univariately with higher mortality were
       identified. A prognostic rule was established in a multivariate approach
       using canonical discriminant analysis. Cut-off values for parameters
       included were determined in order to allow a clinically applicable
       estimate of the individual risk. Variables associated with early
       mortality were hemoglobin, hematocrit, platelet count, albumin, total
       protein, gamma-globulins, and AaDO2. LDH values, percentage of
       neutrophils in the BAL, as well as the cellular immunologic state as
       indicated by CD4-cell count were not significantly associated with the
       outcome. The discriminant function yielded the best classification
       results with the inclusion of hemoglobin, albumin, and gamma-globulins
       (overall accuracy 86%). Two or more of the following parameters were
       associated with a 14-fold increased risk of in-hospital mortality:
       hemoglobin less than 10 g/dl, albumin less than 3 g/dl, and
       gamma-globulins less than 1.2 g/dl. This prognostic rule was 80%
       sensitive and 94% specific with a negative predictive value of 94%,
       yielding an overall accuracy of 91%. Patients with HIV-associated PCP
       with a positive prognostic rule have a 14-fold increased risk for
       in-hospital lethal outcome. This discriminant rule may be helpful in
       identifying patients at risk.
 DE    Adult  AIDS-Related Opportunistic Infections/DRUG THERAPY/*MORTALITY/
       PHYSIOPATHOLOGY  Bacterial Infections/COMPLICATIONS  Bronchoalveolar
       Lavage  Candidiasis/COMPLICATIONS  Female  Hospitals  Human  Leukocyte
       Count  Male  Multivariate Analysis  *Outcome Assessment (Health Care)
       Pneumonia, Pneumocystis carinii/COMPLICATIONS/DRUG THERAPY/
       *MORTALITY/PHYSIOPATHOLOGY  Retrospective Studies  Risk Factors  JOURNAL
       ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
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