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2015 ; 94
(16
): e768
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Clinical Usefulness of HRCT in Assessing the Severity of Pneumocystis jirovecii
Pneumonia: A Cross-sectional Study
#MMPMID25906111
Chou CW
; Chao HS
; Lin FC
; Tsai HC
; Yuan WH
; Chang SC
Medicine (Baltimore)
2015[Apr]; 94
(16
): e768
PMID25906111
show ga
The aim of this study was to investigate the clinical relevance of thoracic
high-resolution computed tomography (HRCT) in evaluating the severity and outcome
of Pneumocystis jirovecii pneumonia (PJP) in non-AIDS immunocompromised
patients.We measured mean lung attenuation (MLA) and extent of increased
attenuation (EIA) of PJP lesions on thoracic HRCT in 40 non-AIDS
immunocompromised patients with PJP diagnosed by demonstration of the pathogens
in cytological smears of bronchoalveolar lavage fluid. The MLA and EIA of PJP
lesions on thoracic HRCT were used to investigate the severity of PJP.
Clinically, the severity of PJP was determined by arterial oxygen
tension/fraction of inspired oxygen concentration (PaO2/FiO2) ratio, acute
physiology and chronic health evaluation (APACHE) II scores, the need of
mechanical ventilation, and death.MLA highly correlated with EIA of PJP lesions
(??=?0.906, P?0.001). MLA and EIA of PJP lesions significantly correlated with
PaO2/FiO2 (??=?-0.481 and -0.370, respectively and P?=?0.007 and 0.044,
respectively). When intensive care unit (ICU) admission and HRCT performed were
within 2 days, MLA and EIA of PJP lesions were significantly correlated with
APACHE II score (??=?0.791 and 0.670, respectively and P?=?0.001 and 0.009,
respectively). There were significant differences in the values of MLA and EIA of
PJP lesions between patients with and without assisted mechanical ventilator
(MLA, median and [interquartile range, IQR, 25%, 75%] -516.44 [-572.10, -375.34]
vs -649.27 [-715.62, -594.01], P?0.001 and EIA, median and [IQR 25%, 75%] 0.75
[0.66, 0.82] vs 0.53 [0.45, 0.68], P?=?0.003, respectively). The data of MLA and
EIA of PJP lesions had limited value in identifying survivors and
non-survivors.The MLA and EIA values of PJP lesions measured on thoracic HRCT
might be valuable in assessing the severity of PJP in non-AIDS immunocompromised
patients, but might have limited value in predicting the mortality of the
patients.