Adjunctive corticosteroids therapy for Pneumocystis pneumonia with ARDS in non-HIV immunocompromised patients：a retrospective cohort study

Abstract

Background Adjuvant corticosteroids are effective in patients with human immunodeficiency virus (HIV)-associated Pneumocystis jirovecii pneumonia (PCP) patients, but the effectiveness of adjuvant corticosteroids in non-HIV PCP remained controversial. This study aimed to evaluate the effects of steroids in non-HIV PCP patients with acute respiratory distress syndrome (ARDS). Methods This retrospective observational study included non-HIV PCP patients with ARDS admitted to the respiratory intensive care unit (RICU) of Beijing Chao-Yang Hospital from 2015 to 2022 were included. We compared demographics, clinical characteristics, and outcomes between patients who received a 21-day course of standard-dose steroids and those who received low-dose steroids. Kaplan-Meier curve and log-rank test were performed to compare the survival time between standard-dose steroid and low-dose steroid patients. Cox regression analysis was performed to identify risk factors for 28- and 60-day mortality. Results A total of 105 non-HIV PCP with ARDS were identified, 48 in the 21-day course of standard-dose steroid group (66.7% male, 50.5±12.6 years) and 57 in the low-dose steroid group(61.4% male, 55.5±14.2 years). 60-day mortality was significantly different between the two groups (63.2% vs 48.3%, p=0.04), but 28-day mortality was not (50.8% vs 35.4%, p=0.11). After adjustment for confounders, 60-day mortality (adjusted hazard ratio: 0.415, 95% confidence interval: 0.227-0.760) was lower in the 21-day standard-dose steroid group compared with those in the low-dose steroid group. 21-day standard-dose steroids were associated with lower 60-day mortality in patients aged<65 years, no smokers, requiring mechanical ventilation, lactic dehydrogenase≥ 495U/L, and PaO2/FiO2 ratio<150mmHg. There were no differences in co-infections and gastrointestinal bleeding between the two groups. Conclusions In conclusion, the 21-day standard-dose steroids therapy significantly reduced 60-day mortality without major complications in the non-HIV immunocompromised population with severe PCP with ARDS.