Evaluation of a prognostic score. Pneumocystis carinii pneumonia in HIV-infected patients

Abstract

Study objective: (1) To evaluate a clinical score predicting the early death from Pneumocystis carinii pneumonia (PCP) in HIV-infected patients and to compare it with lactate dehydrogenase (LDH) levels and Karnofsky's performance score. (2) To compare the association of this score and partial oxygen pressure (PaO2) at baseline (at ambiant air) with change in therapy.

Design: This clinical score was based on respiratory rate, degree of fever, cough, dyspnea, chest tightness, and chest radiographic findings. It was prospectively assessed in patients enrolled in two clinical trials for primary therapy of PCP.

Setting: A university hospital with a large AIDS population.

Patients: PCP scores (PCPSc) were assessed on treatment days (D) 0, D3, D7, D14, and D21 for 78 patients with mild to moderately severe PCP (PaO2 > 50 mm Hg at entry at room air). Regardless of the treatment received, these patients were stratified into two groups (survivors and nonsurvivors) within 45 days after the beginning of therapy.

Measurements and results: The PCPSc was associated with 45 days survival at treatment D3 (p = 0.03) and D14 (p < 0.001). Its decrease was significant between D0 and D7 and between D7 and D14 for survivors only. The LDH levels during the treatment course did not correlate with outcome. The fall in LDH values was significant only for survivors between D7 and D14 of therapy. The PaO2 at hospital admission was associated with death at 45 days and was well correlated with the PCPSc on D0 by single and multiple linear regression (R = 0.60, p < 0.0001). The PCPsc on D0 was associated with the change of initial therapy due to failure or drug adverse effects whereas PaO2 on D0 was associated only with treatment failure.

Conclusions: For HIV-infected patients with mild to moderately severe PCP, this clinical score is easy to assess and has a prognostic value for survivors. It could be helpful to predict both treatment failure and occurrence of severe adverse drug reactions. The PCPSc should be validated in a larger number of patients, including those with more severe forms of PCP.