Retrospective Analysis Of Risk Factors For Severe Pneumocystis Yerbii Pneumonia

Objective:To explore the risk factors of severe pneumocystis yerbii pneumonia,and to provide some reference for clinicians to evaluate the severity of the disease and guide the treatment.Methods:In this study,139 patients diagnosed with PJP in Jiangxi Provincial People’s Hospital from July 2019 to February 2023 were selected,excluding 8 patients who did not meet the criteria,and a total of 131 patients with PJP were included for retrospective analysis.According to whether the patients met the diagnostic criteria for severe pneumonia after admission,they were divided into the general group and the severe group.There were 51 cases in the general group,including 36 males and15 females,aged 50.02±14.37 years old.In the severe treatment group,there were 80 cases,including 12 deaths,33 cases of automatic discharge,including 58 males and22 females,with an average age of 56.33±15.08 years.Patients diagnosed with PJP were retrieved through the medical record system.According to the inclusion and exclusion criteria,data of 131 patients with PJP were finally collected for retrospective analysis,including general clinical data(age,gender,underlying diseases),laboratory indicators such as blood routine and blood biochemistry,diagnostic methods,and co-infection.SPSS26.0 software was used to analyze the data to compare the differences of all the above indexes between the common PJP group and the severe PJP group.logistic regression analysis was performed to draw ROC curve to evaluate the predictive value of the above indexes in the severe PJP group.P < 0.05 indicated statistical significance.Result:(1)There were significant differences in age,basic immunity(solid organ transplantation,connective tissue disease,chronic kidney disease),WBC,LYM,CRP,PCT,ALB,BUN,LDH and CMV infection between common group and severe group(P < 0.05);There was no significant difference in gender,basic immunity(lymphoma,solid malignancy,HIV),prehospital use of hormones/immunosuppr-essants,G test,diagnostic methods,or other infections(bacteria,viruses,other fungi)(P > 0.05).(2)ROC curve was drawn to evaluate the diagnostic significance of each index for severe PJP: age(sensitivity 0.75,specificity 0.424,optimal cut-off value 46.5);WBC(sensitivity 0.731,specificity 0.667,optimal cut-off value 8.2);LYM(sensitivity 0.813,specificity 0.784,optimal cut-off value 0.615);CRP(sensitivity0.615,specificity 0.788,optimal cut-off value 72.15);PCT(sensitivity 0.365,specificity 0.97,optimal cut-off value 1.29);ALB(Sensitivity 1,specificity 0.471,optimal cut-off value 30);BUN(sensitivity 0.645,specificity 0.515,optimal cut-off value 8.44);LDH(sensitivity 0.923,specificity 0.636,optimal cut-off value 312.5).(3)Univariate analysis showed that age,elevated white blood cells,lymphocytopenia,elevated C-reactive protein,hypoalbumin,elevated blood urea nitrogen,elevated lactate dehydrogenase,and CMV infection may be predictive factors for the development of severe disease or death in PJP patients.After logistic modeling(WBC,LYM,CRP,ALB,LDH,combined with CMV infection),the ROC curve was used to evaluate the value of the model,and the AUC value was 0.983,indicating that the accuracy of the prediction model was very high,that is,the model had a certain value in predicting the development of severe disease or even death.(4)Logisitic multivariate regression analysis suggested that low albumin,lymphocytopenia and CMV infection were independent risk factors for severe PJP.Conclusion:(1)WBC,LYM,CRP,PCT,ALB,BUN,LDH and CMV infection all had a certain value in predicting the risk of severe illness and even death,among which ALB and LYM had the best predictive ability.(2)Hypoalbumin,lymphocytopenia and CMV infection were independent risk factors for severe PJP.