The Evaluation of risk factors and prognostic impact of glucocorticoid therapy among non-HIV patients with Pneumocystis Jirovecii Pneumonia (PCP) Running title：Glucocorticoid therapy among non-HIV patients with PCP

Abstract

Abstract Background Glucocorticoids have been shown to be very effective in the treatment of Human Immunodeficiency Virus (HIV) associated Pneumocystis jirovecii Pneumonia (PCP). However, risk factors and the impact on prognosis in non-HIV-PCP patients remain unclear. Our study aimed to early identification risk factors and prognostic impact of glucocorticoids therapy in non-HIV-PCP patients to decrease patients’ mortality. Methods A retrospective study was conducted on adult (≥ 18 years old) patients diagnosed with non-HIV-PCP in Peking University First Hospital from April 2007 to October 2022. A total of 269 patients with non-HIV-PCP were hospitalized during the period, and 200 patients were eventually included. Demographic data and related clinical data were collected. Univariate and multivariate logistic regression were used to analyze the relationship between variables and poor prognosis. Results A total of 200 non-HIV-PCP patients were included. 29% (58/200) patients died during admission. Univariate analysis showed that age, history of chemotherapy, history of glucocorticoid, autoimmune disease, organ transplantation, respiratory failure, platelet count, neutrophil/lymphocyte ratio, highly sensitive C-reactive protein, albumin, lactic dehydrogenase, d-dimer, bronchoalveolar lavage fluid (BALF)-neutrophil percentage, BALF-lymphocyte percentage, hospital-acquired pneumonia associated pathogen infection, pneumothorax, mediastinal emphysema, caspofungin therapy and high dose (≥ 1mg/(kg· d)) glucocorticoids therapy have a risk of death due to PCP patients. Multivariate analysis showed that age (OR = 1.062, 95%CI 1.021–1.104, P = 0.003), hospital-acquired pneumonia associated pathogen infection (OR = 4.170, 95%CI 1.407–12.357, P = 0.010) and high dose glucocorticoid therapy (OR = 7.047, 95%CI 2.482–20.006, P < 0.001) were independent risk factors for in-hospital death in non-HIV-PCP patients. Conclusions Considering the rapid course of the disease in non-HIV-infected immunocompromised patients. Early identification of high-risk PCP patients is critical to reduce morbidity and mortality. Our study found that non-HIV-PCP patients treated with high doses of glucocorticoids, old age, history of chemotherapy and hospital-acquired pneumonia associated pathogen infection had worse outcomes during hospitalization.