Prognostic Indicators in the Initial Presentation of Pneumocystis carinii Pneumonia: Outcome

6 Nov

The finding of a normal serum LDH level in a symptomatic patient with an abnormal chest roentgenogram should suggest a non-PC P pulmonary process.
Admission clinical and laboratory data were analyzed as prognostic indicators, ie, for their ability to predict survival in patients with P carinii pneumonia. Mean duration of symptoms (fever, dyspnea, cough), physical findings (temperature and crackles), and initial mean leukocyte and lymphocyte counts on admission showed no significant statistical difference between those who survived and those who died. website

Similar findings were reported by Kales et al, although crackles were found more frequently in nonsurvivors in that study. Kovacs et al found that initial respiratory rate, lymphocyte count, and serum albumin levels had some prognostic value. In the present study on admission survivors had a statistically significant (p<0.05) lower mean P(A-a)02 gradient and lower mean serum LDH level (p<0.01) as well as lower mean respiratory rate (p< .05). These findings are in accord with recently published results by Brenner et al, who found that survivors had a lower initial P(A-a)02 gradient. Both Kovacs et al and Kales et al reported an improved prognosis with a higher initial Pa02. The P(A-a)02 gradients were not calculated in the former study. In the latter study normal Pa02 and P(A-a)02 gradients were obtained in 21/109 patients: these patients did not have increased survival.
The lower admission serum LDH and P(A-a)02 gradient findings in survivors may be due to less initial parenchymal damage secondary to Pneumocystis. With appropriate therapy for Pneumocystis, serum LDH levels and P(A-a)02 gradient, measurements returned close to baseline. This usually occurred following 17 to 21 days of therapy.