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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2020

Open Access 01-12-2020 | Hypoxemia | Research

Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies

Authors: Lin Ding, Huixue Huang, Heyan Wang, Hangyong He

Published in: Annals of Intensive Care | Issue 1/2020

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Abstract

Background

Evidence supporting corticosteroids adjunctive treatment (CAT) for Pneumocystis jirovecii pneumonia (PCP) in non-HIV patients is highly controversial. We aimed to systematically review the literature and perform a meta-analysis of available data relating to the effect of CAT on mortality of PCP in non-HIV patients.

Methods

We searched Pubmed, Medline, Embase, and Cochrane database from 1989 through 2019. Data on clinical outcomes from non-HIV PCP were extracted with a standardized instrument. Heterogeneity was assessed with the I2 index. Pooled odds ratios and 95% confidence interval were calculated using a fixed effects model. We analyzed the impact of CAT on mortality of non-HIV PCP in the whole PCP population, those who had hypoxemia (PaO2 < 70 mmHg) and who had respiratory failure (PaO2 < 60 mmHg).

Results

In total, 259 articles were identified, and 2518 cases from 16 retrospective observational studies were included. In all non-HIV PCP cases included, there was an association between CAT and increased mortality (odds ratio, 1.37; 95% confidence interval 1.07–1.75; P = 0.01). CAT showed a probable benefit of decreasing mortality in hypoxemic non-HIV PCP patients (odds ratio, 0.69; 95% confidence interval 0.47–1.01; P = 0.05). Furthermore, in a subgroup analysis, CAT showed a significantly lower mortality in non-HIV PCP patients with respiratory failure compared to no CAT (odds ratio, 0.63; 95% confidence interval 0.41–0.95; P = 0.03).

Conclusions

Our meta-analysis suggests that among non-HIV PCP patients with respiratory failure, CAT use may be associated with better clinical outcomes, and it may be associated with increased mortality in unselected non-HIV PCP population. Clinical trials are needed to compare CAT vs no-CAT in non-HIV PCP patients with respiratory failure. Furthermore, CAT use should be withheld in non-HIV PCP patients without hypoxemia.
Appendix
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Literature
1.
Sepkowitz KA. Pneumocystis carinii pneumonia in patients without AIDS. Clin Infect Dis. 1993;17(Suppl 2):S416–22.CrossRef
2.
Coyle PV, McCaughey C, Nager A, McKenna J, O’Neill H, Feeney SA, Fairley D, Watt A, Cox C, Curran T. Rising incidence of Pneumocystis jirovecii pneumonia suggests iatrogenic exposure of immune-compromised patients may be becoming a significant problem. J Med Microbiol. 2012;61(Pt 7):1009–15.CrossRef
3.
Weng L, Huang X, Chen L, Feng LQ, Jiang W, Hu XY, Peng JM, Wang CY, Zhan QY, Du B. Prognostic factors for severe Pneumocystis jiroveci pneumonia of non-HIV patients in intensive care unit: a bicentric retrospective study. BMC Infect Dis. 2016;16(1):528.CrossRef
4.
Inoue N, Fushimi K. Adjunctive corticosteroids decreased the risk of mortality of non-HIV Pneumocystis pneumonia. Int J Infect Dis. 2019;79:109–15.CrossRef
5.
Wieruszewski PM, Barreto JN, Frazee E, Daniels CE, Tosh PK, Dierkhising RA, Mara KC, Limper AH. Early corticosteroids for Pneumocystis pneumonia in adults without HIV are not associated with better outcome. Chest. 2018;154(3):636–44.CrossRef
6.
Gagnon S, Boota AM, Fischl MA, Baier H, Kirksey OW, La Voie L. Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A double-blind, placebo-controlled trial. N Engl J Med. 1990;323(21):1444–50.CrossRef
7.
Bozzette SA, Sattler FR, Chiu J, Wu AW, Gluckstein D, Kemper C, Bartok A, Niosi J, Abramson I, Coffman J, et al. A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. California Collaborative Treatment Group. N Engl J Med. 1990;323(21):1451–7.CrossRef
8.
Nuesch R, Bellini C, Zimmerli W. Pneumocystis carinii pneumonia in human immunodeficiency virus (HIV)-positive and HIV-negative immunocompromised patients. Clin Infect Dis. 1999;29(6):1519–23.CrossRef
9.
Pareja JG, Garland R, Koziel H. Use of adjunctive corticosteroids in severe adult non-HIV Pneumocystis carinii pneumonia. Chest. 1998;113(5):1215–24.CrossRef
10.
Lemiale V, Debrumetz A, Delannoy A, Alberti C, Azoulay E. Adjunctive steroid in HIV-negative patients with severe Pneumocystis pneumonia. Respir Res. 2013;14:87.CrossRef
11.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.CrossRef
12.
Delclaux C, Zahar JR, Amraoui G, Leleu G, Lebargy F, Brochard L, Schlemmer B, Brun-Buisson C. Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in non-human immunodeficiency virus-infected patients: retrospective study of 31 patients. Clin Infect Dis. 1999;29(3):670–2.CrossRef
13.
Zahar JR, Robin M, Azoulay E, Fieux F, Nitenberg G, Schlemmer B. Pneumocystis carinii pneumonia in critically ill patients with malignancy: a descriptive study. Clin Infect Dis. 2002;35(8):929–34.CrossRef
14.
Pagano L, Fianchi L, Mele L, Girmenia C, Offidani M, Ricci P, Mitra ME, Picardi M, Caramatti C, Piccaluga P, et al. Pneumocystis carinii pneumonia in patients with malignant haematological diseases: 10 years’ experience of infection in GIMEMA centres. Br J Haematol. 2002;117(2):379–86.CrossRef
15.
Roblot F, Le Moal G, Godet C, Hutin P, Texereau M, Boyer E, Prazuck T, Lacroix C, Souala MF, Raffi F, et al. Pneumocystis carinii pneumonia in patients with hematologic malignancies: a descriptive study. J Infect. 2003;47(1):19–27.CrossRef
16.
Bollee G, Sarfati C, Thiery G, Bergeron A, de Miranda S, Menotti J, de Castro N, Tazi A, Schlemmer B, Azoulay E. Clinical picture of Pneumocystis jiroveci pneumonia in cancer patients. Chest. 2007;132(4):1305–10.CrossRef
17.
Aoki Y, Iwamoto M, Kamata Y, Nagashima T, Yoshio T, Okazaki H, Minota S. Prognostic indicators related to death in patients with Pneumocystis pneumonia associated with collagen vascular diseases. Rheumatol Int. 2009;29(11):1327–30.CrossRef
18.
Matsumura Y, Shindo Y, Iinuma Y, Yamamoto M, Shirano M, Matsushima A, Nagao M, Ito Y, Takakura S, Hasegawa Y, et al. Clinical characteristics of Pneumocystis pneumonia in non-HIV patients and prognostic factors including microbiological genotypes. BMC Infect Dis. 2011;11:76.CrossRef
19.
Moon SM, Kim T, Sung H, Kim MN, Kim SH, Choi SH, Jeong JY, Woo JH, Kim YS, Lee SO. Outcomes of moderate-to-severe Pneumocystis pneumonia treated with adjunctive steroid in non-HIV-infected patients. Antimicrob Agents Chemother. 2011;55(10):4613–8.CrossRef
20.
Kim SJ, Lee J, Cho YJ, Park YS, Lee CH, Yoon HI, Lee SM, Yim JJ, Lee JH, Yoo CG, et al. Prognostic factors of Pneumocystis jirovecii pneumonia in patients without HIV infection. J Infect. 2014;69(1):88–95.CrossRef
21.
Kofteridis DP, Valachis A, Velegraki M, Antoniou M, Christofaki M, Vrentzos GE, Andrianaki AM, Samonis G. Predisposing factors, clinical characteristics and outcome of Pneumocystis jirovecii pneumonia in HIV-negative patients. J Infect Chemother. 2014;20(7):412–6.CrossRef
22.
Kotani T, Katayama S, Miyazaki Y, Fukuda S, Sato Y, Ohsugi K. Risk factors for the mortality of Pneumocystis jirovecii pneumonia in non-HIV patients who required mechanical ventilation: a retrospective case series study. Biomed Res Int. 2017;2017:7452604.CrossRef
23.
Liu CJ, Lee TF, Ruan SY, Yu CJ, Chien JY, Hsueh PR. Clinical characteristics, treatment outcomes, and prognostic factors of Pneumocystis pneumonia in non-HIV-infected patients. Infect Drug Resist. 2019;12:1457–67.CrossRef
24.
National Institutes of Health-University of California Expert Panel for Corticosteroids as Adjunctive Therapy for Pneumocystis P. Consensus statement on the use of corticosteroids as adjunctive therapy for Pneumocystis pneumonia in the acquired immunodeficiency syndrome. N Engl J Med. 1990;323(21):1500–4.CrossRef
25.
Ewald H, Raatz H, Boscacci R, Furrer H, Bucher HC, Briel M. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV infection. Cochrane Database Syst Rev. 2015;4:CD006150.
Metadata
Title
Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies
Authors
Lin Ding
Huixue Huang
Heyan Wang
Hangyong He
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2020
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-020-00649-9

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