Prognostic Analysis Of Interstitial Pulmonary Disease Complicated With Pneumocystis Pneumonia

[Introduction]Interstitial pulmonary disease is a group of common allogeneic diseases in the Department of Respiratory Medicine,which can be caused by different basic diseases.The treatment of most interstitial pulmonary diseases includes the use of glucocorticoids,immunosuppressants or even biological agents.Pneumocystis pneumoniae is a common exacerbation cause of dyspnea,respiratory failure and even death in patients with impaired immune function.Therefore,this study was carried out as follows:Part Ⅰ:The clinical features and prognostic impact of basic interstitial pulmonary disease in patients with pneumocystis pneumonia[Objectives]To compare the clinical features and prognostic impact of HIV negative pneumocystis jevi pneumonia(PJP)patients complicated with interstitial pulmonary disease(ILD).[Methods]From January 2014 to January 2021 in Peking Union Medical College Hospital,231 HIV-negative patients with clinical diagnosis of PJP(HIV--PJP),aged≥18 years,were included in the retrospective study.The patients were evaluated by respiratory experts and imaging experts and divided into interstitial pulmonary disease(HIV--ILDPJP)group and non-ILD(HIV--non-ILD-PJP)group at baseline.Data were collected including demographic characteristics,basic disease,pre-onset treatment,clinical presentation,laboratory results,chest imaging features,co-infection,treatments,and outcomes.The primary endpoint was death.Kaplan-Meier method and multivariate Cox regression model were used to explore the possible prognostic factors in patients with pneumocystis pneumonia and interstitial pulmonary disease.[Results]This retrospective study included a total of 378 patients with confirmed HIVnegative PJP,including 133 patients with ILD and 245 patients without ILD.The treatment rates of glucocorticoid and corticosteroid impulse therapy before the onset of infection in ILD group were significantly higher than that in non-ILD group.The incidence of cough,sputum,breathlessness,weight loss,respiratory failure,emphysema and mortality in ILDPJP group were significantly higher than those in non-ILD-PJP group.Meanwhile,the hematologic indexes including HGB,IgG and IgA were higher in ILD-PJP group.There were no statistically significant differences in co-infection and treatment plan between the two groups.Kaplan-Maier survival curve showed the prognosis of ILD-PJP was worse,and the mortality risk of ILD-PJP was 1.69 times that of patients without ILD.Cox stepwise regression analysis indicated that elevated LDH or elevated hsCRP,Aspergillus infection,radiographic findings of honeycomb lung,and mechanical ventilation were adverse factors affecting the prognosis of patients.Futher more,elevated LDH or BDG,Aspergillus,HAP infection and non-invasive mechanical ventilation were adverse factors affecting the prognosis of patients with HIV--ILD-PJP.[Conclusions]The clinical characteristics of HIV--PJP were affected by ILD.The mortality risk of HIV--ILD-PJP was higher.Elevated LDH or BDG,Aspergillus,HAP infection and non-invasive mechanical ventilation could be independent risk factors for death.Part Ⅱ:The clinical features and prognostic impact of different subgroups of interstitial pulmonary disease in patients with pneumocystis pneumonia[Objectives]To explore the clinical features and prognostic factors in different subgroups of interstitial pulmonary disease(ILD)in patients with pneumocystis pneumonia(PJP).[Methods]Based on the first part of the study,according to the stratification of primary disease,HIV--ILD-PJP patients were divided into CTD-ILD group and non-CTD-ILD group.Data were collected including demographic characteristics,basic disease,pre-onset treatment,clinical presentation,laboratory results,chest imaging features,co-infection,treatments,and outcomes.The primary endpoint was death.[Results]There were 133 patients in HIV--ILD-PJP group,including 93 patients with CTD-ILD and 40 patients with non-CTD-ILD.The treatment rate of corticosteroid impulse therapy and immunosuppressor before the onset of infection in CTD-ILD group was significantly higher than that in non-CTD-ILD group.There were no significant differences in clinical manifestations,co-infection,treatment and clinical outcomes between the two groups.There was no significant difference in survival curve analysis between the two groups.[Conclusions]There was no significant difference in survival curve analysis between CTD-ILD group and non-CTD-ILD group.