AIDS-related Pneumocystis carinii pneumonia in the era of adjunctive steroids - Implication of BAL neutrophilia

Factors predictive of mortality in patients with AIDS and Pneumocystis cari nii pneumonia (PCP) were identified before the introduction of adjunctive s teroids, but they have not been reevaluated since. Because PCP still occurs in AIDS, remaining fatal in some cases, we conducted a multivariate analys is of factors predicting mortality in patients with HIV-positive PCP manage d from 1990 to 1995, i.e., after the consensus conference on the use of adj unctive steroids. The predictive value of clinical, laboratory, and broncho alveolar lavage (BAL) data at admission and during the course of PCP was st udied retrospectively using multivariate methods, in 144 patients with AIDS . Overall mortality was 21.5%. The univariate analysis identified seven fac tors predictive of 90-d mortality: Pa-O2 on room air < 60 mm Hg, lactate de hydrogenase > 1,000 IU, albuminemia < 30 g/L, BAL neutrophilia > 10%, nosoc omial infection, pneumothorax, and a need for mechanical ventilation. Four of these factors were independently associated with 90-d mortality in the m ultivariate analysis; among them, two were evaluable at admission, namely, Pa-O2 < 60 mm Hg on room air and BAL neutrophilia > 10%, and two during hos pitalization, namely, the development of pneumothorax and a need for mechan ical ventilation. Moreover, BAL neutrophilia was correlated to occurrence o f pneumothorax and a need for mechanical ventilation. In the era of adjunct ive steroid use, AIDS-related PCP remains fairly common. Two independent fa ctors evaluable at admission, Pa-O2 on room air and BAL neutrophilia, are p redictive of death.