Independent risk of mechanical ventilation for AIDS-related Pneumocystis carinii pneumonia associated with bronchoalveolar lavage neutrophilia

The use of mechanical ventilation (MV) for AIDS-related Pneumocystis carini i pneumonia (PCP) has varied overtime. The introduction of adjunctive cor t icosteroic; therapy has changed the patophysiology of PCR In the present st udy, we attempted to identify factors predictive of severe respiratory fail ure requiring MV amongst patients with PCP treated in the era of adjunctive corticosteroid therapy Furthermore, we studied factors associated with sur vival in relation to MV Of 170 consecutive patients with AIDS-related PCR 1 8 (11%) required MV Thirteen of 18 ventilated patients died (72%). In a log istic regression analysis, higher age, increased brnchooalveolar lavage (BA L) neutrophilia and a positive BAL cyto megalovirus CMV culture were associ ated with the need of MV In multivariate analyses, only BAL neutrophilia re mained independently predictive of mechanica ventilation. In conclusion, sh ort-term mortality remained high after the introduction of adjunctive corti costeroid therapy BAL neutrophilia may be a useful prognostic marker to ide ntify patients at high risk of requiring mechanical ventilation. (C) 2001 H arcourt Publishers Ltd.