A RAPID PREADMISSION METHOD FOR PREDICTING INPATIENT COURSE OF DISEASE FOR PATIENTS WITH HIV-RELATED PNEUMOCYSTIS-CARINII PNEUMONIA

Pneumocystis carinii pneumonia (FCP) has been the most common reason f or hospitalization and the most common cause of death for persons with HIV infection. Hospital mortality rates for PCP range from 10 to 60%. Studies that evaluate differences in hospital mortality rates must co ntrol for differences in patient severity of illness. We developed a s imple staging system for categorizing severity of illness in patients with PCP. We analyzed the relation between clinical factors and in-hos pital mortality for 576 hospitalized patients with HIV-related PCP tre ated at 56 hospitals for the years 1987 to 1990. Four stages of PCP co uld be identified based on three routinely measured clinical variables : alveolar-arterial oxygen difference, total lymphocyte count, and bod y mass index. The mortality rate increased by stage: 1% for Stage 1, 8 % for Stage 2, 23% for Stage 3, and 48% for Stage 4. The four-stage se verity system compared well with previous models developed for AIDS an d for PCP, and is easier to use in clinical practice. Our staging syst em identifies patients with a high and low risk of in-hospital death u pon admission. Physicians may benefit from consideration of PCP stage in deciding on management strategies. In addition, researchers involve d in clinical trials of new agents for FCP might consider stratificati on by PCP stage in order to define homogenous groups.