Prognostic Indicators in the Initial Presentation of Pneumocystis carinii Pneumonia

1 Nov

Prognostic Indicators in the Initial Presentation of Pneumocystis carinii PneumoniaPneumocystis carinii pneumonia (PCP) is the most frequently diagnosed pulmonary opportunistic infection in patients with the acquired immunodeficiency syndrome (AIDS). Between 50 and 80 percent of patients with P carinii survive their initial episode. Early clinical experience at New York University Medical Center suggested that certain routine laboratory data were highly indicative of the diagnosis of Pneumocystis pneumonia and had prognostic implications. The elevation of serum lactic dehydrogenase levels usually accompanied the diagnosis of PCP and distinguished it from other pulmonary opportunistic processes in AIDS patients. comments

Further, the degree of its elevation as well as the increase in admission, room air P(A-a)Oa gradient appeared to have prognostic implications. The present study analyzes the diagnostic and prognostic implications of serum LDH elevation in patients with AIDS or patients thought to have AIDS who presented with P cariniipneumonia.
Material and Methods
Patient Population
We evaluated 185 consecutive patients with P carinii pneumonia during their initial presentation with AIDS. Thirty-five were eliminated because: (1) 25 patients had concurrent pulmonary infections (cytomegalovirus, Legionella, Cryptococcus, and Mycobacterium tuberculosis or M avium-intracellulare); and (2) ten patients had diffuse liver function abnormalities (elevations in serum SGOT, SGPT, LDH, and alkaline phosphatase levels). Thus, 150 patients presenting with Pneumocystis as their initial manifestation of AIDS composed group 1. Sixty-seven newly diagnosed AIDS patients with pulmonary processes other than P carinii pneumonia (and no previous history of pneumonia) composed group 2. These patients had pulmonary disease due to: Kaposis sarcoma (30 patients), cryptococcal pneumonia (five), tuberculous infections (11), bacterial pneumonia (four, all with S pneumonia), coccidiomycosis (one), cytomegalovirus (five), nonspecific interstitial inflammation (12), lymphocytic interstitial pneumonia (two), and pulmonary lymphoma (one). A third group of 15 AIDS patients with no pulmonary manifestation composed group 3.