Survival in Immunocompromised Adults with Pneumocystis jirovecii Pneumonia: A Multicenter ID-IRI Study

Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection in immunocompromised patients. The aim of this study was to identify risk factors associated with in-hospital 30-day all-cause mortality among PJP in patients with HIV and hematologic malignancies where PJP is the most prevalent.

We conducted a multicenter, international, retrospective cohort study of consecutive hospitalized patients aged > 17 years with PJP between January 1, 2010, and March 1, 2024. Only patients with laboratory-confirmed PJP were included.

Overall, 156 patients were included to study. Of the 156 patients, 115 (73.7%) were male, and the median age was 43 years (IQR 35-52). Of the patients, 130 (83.3%) were people living with HIV, including 126 newly diagnosed cases, while 26 (16.7%) had hematologic malignancies. Overall, PJP prophylaxis was used in only 4.5% of patients. According to the immunofluorescence assay or conventional staining methods used as the reference standard, the positivity rate of P. jirovecii PCR in BAL samples was 96.4%. Intensive care unit admission was required for 60 patients (38.5%), of whom 51 (85.0%) required mechanical ventilation. The overall in-hospital 30-day all-cause mortality rate was 14.1%. In the multivariable logistic regression analysis, higher respiratory rate (OR 1.092; 95% CI 1.002-1.190), higher SOFA score (OR 1.757; 95% CI 1.311-2.356), increased neutrophil count (OR 1.332; 95% CI 1.141-1.555), pleural effusion on chest X-ray (OR 7.268; 95% CI 1.382-38.212), and a prior history of PJP (OR 19.537; 95% CI 1.462-261.2) were independently associated with increased in-hospital 30-day all-cause mortality.

Our findings indicate that greater clinical severity and respiratory compromise are associated with increased mortality risk, underscoring the value of early recognition of high-risk patients to guide timely management.