Predictors of pneumocystosis or tuberculosis in HIV-infected Asian patients with AFB smear-negative sputum pneumonia
Le Minor, O.; Germani, Y.; Chartier, L.; Lan, N.Huu.; Lan, N.T.P.; Duc, N.H.; Laureillard, D.; Fontanet, A.; Sar, B.; Saman, M.; Chan, S.; L'Her, P.; Mayaud, C.; Vray, M.
Journal of Acquired Immune Deficiency Syndromes 48(5): 620-627
2008
ISSN/ISBN: 1525-4135 PMID: 18645508 DOI: 10.1097/qai.0b013e31817efb3cDocument Number: 202344
Objectives: To identify predictors of Pneumocystis jiroveci pneumonia (PCP) or pulmonary tuberculosis (TB) in acid-fast bacillus smear-negative HIV-infected patients and to develop clinical prediction rules.Design: A cohort study conducted in consecutive hospitalized Asian patients.Methods: Multivariate analyses were performed on the Cambodian sample to determine clinical, radiological, and biological predictors of PCP or TB at hospital admission. The Vietnamese sample was kept for independent validation.Results: In Cambodia, the gold standard technique for TB and PCP were fulfilled in 172 (27 cases) and 160 (84 cases) patients, respectively. For TB, independent predictors included the following: headache [odds ratio (OR) 3.0; 95% confidence interval (CI) 1.04 to 8.6], localized radiological opacity (OR 5.8; 95% CI 1.9-17.9), and mediastinal adenopathy (OR 10. 1; 95% CI 3.5 to 29.0); and for PCP: resting oxygen saturation < 90% (OR 3.3; 95% CI 1.3 to 8.5 for resting arterial oxygen saturation >= 80%; and OR 9.1; 95% CI 1.8 to 44.5 for resting arterial oxygen saturation < 80%), trimethoprim-sulphamethoxazole prophylaxis (OR 0.1; 95% CI 0.04 to 0.6), and diffuse radiological shadowing (OR 7.0; 95% CI 2.7 to 18.6). PCP risk predicted by a score based on these 3 factors ranged from 3% to 92% (Cambodia). When tested on Vietnamese patients (n = 69, 38 with PCP), the score maintained correct predictive ability (c-index 0.72) but with poor calibration.Conclusions: The PCP score could provide a useful clinical tool to identify PCP among acid-fast bacillus smear-negative pneumonia and start specific therapy.