Lymphocyte subset analysis to evaluate the prognosis of HIV-negative patients with pneumocystis pneumonia

Abstract

Objectives: We analysed the peripheral blood lymphocyte subsets of human immunodeficiency virus (HIV)-negative patients infected with pneumocystis pneumonia (PCP) to determine the relationships between the levels of different types of lymphocytes and the prognosis of patients.

Methods: We retrospectively reviewed HIV-negative patients with PCP diagnosed in our department. All the eligible patients underwent lymphocyte subset analysis on admission.

Results: A total of 88 HIV-negative PCP patients were enrolled in the study. In univariate analyses, low CD4+ T cell count, low CD8+ T cell count, and low natural killer cell (NK cell) count were associated with higher in-hospital mortality. CD8+ T cell count ≤300/μL was found to be an independent risk factor for poor prognosis in multivariate logistical regression analysis (p = 0.015, OR = 11.526, 95% CI = 1.597-83.158). Although low CD4+ T cell and NK cell counts were not independent risk factors, the mortality rates of PCP patients decreased as the CD4+ T cell and NK cell counts increased.

Conclusion: The immune process of Pneumocystis jirovecii infection is complex but important. We propose that lymphocyte subsets could give clinicians a better understanding of patient immune status, helping with the early identification of potentially lethal infections and treatment decision making, such as adjusting the immunosuppressive regimen and choosing an appropriate patient monitoring level.

Fig. 1

ROC curves for the predictors of in-hospital mortality for CD4+ T, CD8+ T, and NK cell counts

Fig. 2

The 3-month mortality rates determined according to the levels of CD4+ T, CD8+ T, and NK cell counts over different ranges

Fig. 3

Survival curve for the Cox regression hazards model for the relationship between CD8+ T cell count and 3-month mortality