Determinants of short- and long-term outcome in patients with respiratory failure caused by AIDS-related Pneumocystis carinii pneumonia

Objectives: To determine (1) predictors of in-hospital mortality and long-t erm survival in patients with acute respiratory failure (ARF) caused by acq uired immunodeficiency syndrome-related Pneumocystis carinii pneumonia (PCP ) and (2) long-term survival for patients with ARF relative to those withou t ARF. Methods: A retrospective medical chart review was conducted of all cases of PCP-related ARF for which the patient was admitted to the intensive care u nit of a single tertiary care institution between 1991 and 1996. Data were extracted regarding physiologic scores, relevant laboratory values, and dur ation of previous maximal therapy with combined anti-PCP agents and cortico steroids at entry to the intensive care unit. Duration of survival was dete rmined by Kaplan-Meier methods from date of first hospital admission and co mpared for patients with and without ARF. Results: There were 41 admissions to the intensive care unit among 39 patie nts, with 56.4% in-hospital mortality. Higher physiologic scores (Acute Phy siology and Chronic Health Evaluation II [APACHE II]. Acute Lung Injury, an d modified Multisystem Organ Failure scores) were predictive of in-hospital mortality. Duration of previous maximal therapy also predicted in-hospital mortality (45% for patients with <5 days of previous maximal therapy vs 88 % for those with greater than or equal to 5 days of previous maximal therap y; P = .03). Combining physiologic scores and duration of previous maximal therapy enhanced prediction of in-hospital mortality. There was no differen ce in long-term survival between patients with PCP with ARF and those witho ut ARF (P = .80), and baseline characteristics did not predict long-term su rvival. Conclusions: In-hospital mortality of patients with acquired immunodeficien cy syndrome-related PCP and ARF is predicted by duration of previous maxima l therapy and physiologic scores, and their combination enhances predictive accuracy. Long-term survival of patients with ARF caused by PCP is compara ble to that of patients with PCP who do not develop ARF, and determinants o f in-hospital mortality do not predict longterm survival.