EVALUATION OF A PROGNOSTIC SCORE - PNEUMOCYSTIS-CARINII PNEUMONIA IN HIV-INFECTED PATIENTS

Study objective: (1) To evaluate a clinical score predicting the early death from Pneumocystis carinii pneumonia (PCP) in HIV-infected patie nts and to compare it with lactate dehydrogenase (LDH) levels and Karn ofsky's performance score. (2) To compare the association of this scor e and partial oxygen pressure (PaO2) at baseline (at ambiant air) with change in therapy. Design: This clinical score was based on respirato ry rate, degree of fever, cough, dyspnea, chest tightness, and chest r adiographic findings. It was prospectively assessed in patients enroll ed in two clinical trials for primary therapy of PCP. Setting: A unive rsity hospital with a large AIDS population. Patients: PCP scores (PCP Sc) were assessed on treatment days (D) 0, D3, D7, D14, and D21 for 78 patients with mild to moderately severe PCP (PaO2 >50 mm Hg at entry at room air). Regardless of the treatment received, these patients wer e stratified into two groups (survivors and nonsurvivors) within 45 da ys after the beginning of therapy. Measurements and results: The PCPSc was associated with 45 days' survival at treatment D3 (p=0.03) and D1 4 (p<0.001). Its decrease was significant between D0 and D7 and betwee n D7 and D14 for survivors only. The LDH levels during the treatment c ourse did not correlate with outcome. The fall in LDH values was signi ficant only for survivors between D7 and D14 of therapy, The PaO2 at h ospital admission was associated with death at 45 days and was well co rrelated with the PCPSc on D0 by single and multiple linear regression (R=0.60, p<0.0001). The PCPsc on D0 was associated with the change of initial therapy due to failure or drug adverse effects whereas PaO2 o n D0 was associated only with treatment failure. Conclusions: For HIV- infected patients with mild to moderately severe PCP, this clinical sc ore is easy to assess and has a prognostic value for survivors. It cou ld be helpful to predict both treatment failure and occurrence of seve re adverse drug reactions, The PCPSc should be validated in a larger n umber of patients, including those with more severe forms of PCP.