Survival in Immunocompromised Adults with Pneumocystis jirovecii Pneumonia: A Multicenter ID-IRI Study

Abstract

PURPOSE: Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection in immunocompromised patients. The aim of this study was to identify risk factors associated with in-hospital 30-day all-cause mortality among PJP in patients with HIV and hematologic malignancies where PJP is the most prevalent. METHODS: We conducted a multicenter, international, retrospective cohort study of consecutive hospitalized patients aged > 17 years with PJP between January 1, 2010, and March 1, 2024. Only patients with laboratory-confirmed PJP were included. RESULTS: Overall, 156 patients were included to study. Of the 156 patients, 115 (73.7) were male, and the median age was 43 years (IQR 35-52). Of the patients, 130 (83.3) were people living with HIV, including 126 newly diagnosed cases, while 26 (16.7) had hematologic malignancies. Overall, PJP prophylaxis was used in only 4.5 of patients. According to the immunofluorescence assay or conventional staining methods used as the reference standard, the positivity rate of P. jirovecii PCR in BAL samples was 96.4. Intensive care unit admission was required for 60 patients (38.5), of whom 51 (85.0) required mechanical ventilation. The overall in-hospital 30-day all-cause mortality rate was 14.1. In the multivariable logistic regression analysis, higher respiratory rate (OR 1.092; 95 CI 1.002-1.190), higher SOFA score (OR 1.757; 95 CI 1.311-2.356), increased neutrophil count (OR 1.332; 95 CI 1.141-1.555), pleural effusion on chest X-ray (OR 7.268; 95 CI 1.382-38.212), and a prior history of PJP (OR 19.537; 95 CI 1.462-261.2) were independently associated with increased in-hospital 30-day all-cause mortality. CONCLUSIONS: Our findings indicate that greater clinical severity and respiratory compromise are associated with increased mortality risk, underscoring the value of early recognition of high-risk patients to guide timely management.