Previous corticosteroid exposure associates with an increased Pneumocystis jirovecii pneumonia mortality among HIV-negative patients: a global research network with a follow-up multicenter case-control study

Background: HIV-negative patients have substantial mortality from Pneumocystis jirovecii pneumonia (PJP). We lack predictors of HIV-negative PJP-associated mortality. Objective: We aim to characterize the role of prior corticosteroid exposure in PJP-related mortality. Methods: We queried a global re...

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Published in:Therapeutic advances in infectious disease 2023-01, Vol.10
Main Authors: Vargas Barahona, Lilian, Molina, Kyle C., Pedraza-Arévalo, Laura C., Sillau, Stefan, Tagawa, Alex, Scherger, Sias, Chastain, Daniel B., Shapiro, Leland, Tuells, Jose, Franco-Paredes, Carlos, Hawkins, Kellie L., Maloney, James P., Thompson, George R., Henao-Martínez, Andrés F.
Format: Article
Language:English
Subjects:
Corticosteroids
Dexamethasone
Diagnosis
Ferritin
HIV
Human immunodeficiency virus
Hypoxia
Infectious Diseases Due to Therapeutic Immunosuppression
Lymphopenia
Mortality
Pneumocystis jirovecii
Pneumonia
Prednisone
Prophylaxis
Steroids
Survival analysis
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Summary:Background: HIV-negative patients have substantial mortality from Pneumocystis jirovecii pneumonia (PJP). We lack predictors of HIV-negative PJP-associated mortality. Objective: We aim to characterize the role of prior corticosteroid exposure in PJP-related mortality. Methods: We queried a global research network to identify adult HIV-negative patients with PJP with or without corticosteroid exposure in the preceding year before diagnosis (n = 8,021). We performed a propensity score-matched analysis to adjust baseline patient characteristics and analyzed outcomes. We follow-up the results with a multicenter ten years retrospective case-control cohort of HIV-negative patients tested for PJP by PCP Direct Fluorescent Antigen. We used a Cox proportional hazards model for survival analysis. Results: 1822 HIV-negative propensity-scored matched patients with prior corticosteroid exposure had significantly increased 10 weeks (16% versus 9%, p 
ISSN:2049-9361
2049-937X
DOI:10.1177/20499361231159481