756 - Use Risk Factors to Early Screen Pneumocystis Pneumonia in Hospitalized Patients

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Presenting Author(s)

Ruihong Luo

Assistant Clinical Professor
University of California Los Angeles
Irvine, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: The diagnosis of Pneumocystis pneumonia (PCP) may be delayed or missed if the underlying risk factors are not recognized, particularly in HIV-uninfected patients.

Methods: The adult hospitalized patients (≥18 years) with pneumonia were selected from the Nationwide Inpatient Sample database (2005-2014). The in-hospital outcomes of PCP patients including mortality, length of hospital stay (LOS) and charge were analyzed. The risk factors for PCP were evaluated by Logistic regression. A risk-adjusted model to screen PCP in HIV-uninfected patients was developed by discriminant analysis.

Results: 24,025,696 hospitalized patients with pneumonia were identified, including 135,749 PCP patients. The incidences of PCP in pneumonia patients were 0.12% in HIV-uninfected group and 30.5% in HIV-infected group respectively. Comparing with other pneumonia patients, those with PCP had higher mortality (11.8% vs. 8.2%), longer LOS (median 8 vs. 5 days) and increased hospital charges (median $40,082 vs. $26,980). HIV infection was the major risk factor for PCP (OR=270.2, 95% CI 264.5-276) in all patients with pneumonia. In HIV-uninfected patients, the comorbidities including lymphoma (OR=10.7, 95% CI 10.2-11.2), CMV infection (OR=8.1, 95% CI 7.6-8.7), leukemia (OR=6.8, 95% CI 6.4-7.1), metastatic cancer (OR=5.3, 95% CI 4.6-6.0), immune thrombocytopenic purpura (OR=5.0, 95% CI 4.5-5.5), chronic steroid use (OR=4.1, 95% CI 3.9-4.3), solid organ transplant (OR=3.5, 95% CI 3.3-3.8), inflammatory bowel disease (OR=2.6, 95% CI 2.4-2.8), connective tissue disease (OR=2.4, 95% CI 2.3-2.6) and non-metastatic solid tumor (OR=2.3, 95% CI 2.1-2.4) were associated with increased risk for PCP. A risk-adjusted model composed of risk factors above could help to screen PCP with the sensitivity 42.9%, specificity 94.4% and accurate rate 94.3% (Table 1).Table 1

Conclusion: PCP should be considered as one of the differential diagnoses in patients with pneumonia if they have underlying risk factors other than HIV infection. The risk-adjusted model can help to early screen PCP for HIV-uninfected patients before the pathogen test.