Adjunctive Corticosteroids decreased the risk of mortality of non-HIV Pneumocystis Pneumonia

Abstract

Objectives: A mortality rate of non-human immunodeficiency virus–infected pneumocystis pneumonia (non-HIV PCP) is 30–60%. But the effectiveness of adjunctive corticosteroids with trimethoprim–sulfamethoxazole has been unclear, and we examined whether it lowered risk of mortality in non-HIV PCP. Methods: We did an observational study of adult non-HIV PCP patients from April 2010 through March 2016, using Japanese nationwide healthcare records of the Diagnostic Procedure Combination database (DPC). The risk was estimated by the time-dependent Cox regression analyses with inverse probability weights. Result: 1299 eligible non-HIV PCP patients were identified. 737 patients were severe respiratory status (partial pressure of oxygen in arterial blood [PaO 2 ] ≤60 mm Hg) and 562 were moderate (PaO 2 >60 mm Hg) at hospital admission. Among patients with severe respiratory status, the adjunctive corticosteroids was associated with lower risk of 60-day mortality (HR 0.71; 95% confidence interval [CI], 0.55–0.91), and significantly decreased mortality rates (24.7% vs 36.6%, P = 0.006). In contrast, no significant differences were observed in the risk of 60-day mortality (HR 1.17; 95% CI, 0.73–1.86) and the mortality rate (10.9% vs 9.1%, P = 0.516) among patients with moderate respiratory status. Conclusion: The adjunctive corticosteroids were associated with lower risk of 60-day mortality in severe non-HIV PCP patients.