صورة
Patient selection flowchart.
| العنوان: | Patient selection flowchart. |
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| المؤلفون: | Kohei Miyake, Satoru Senoo, Ritsuya Shiiba, Junko Itano, Goro Kimura, Tatsuyuki Kawahara, Tomoki Tamura, Kenichiro Kudo, Tetsuji Kawamura, Yasuharu Nakahara, Hisao Higo, Daisuke Himeji, Nagio Takigawa, Nobuaki Miyahara |
| سنة النشر: | 2024 |
| مصطلحات موضوعية: | Medicine, Cell Biology, Molecular Biology, Biotechnology, Immunology, Developmental Biology, Cancer, Science Policy, Infectious Diseases, Virology, Computational Biology, Biological Sciences not elsewhere classified, retrospective cohort study, optimal cutoff point, lower serum albumin, lower lymphocyte count, human immunodeficiency virus, higher lactate dehydrogenase, developing pneumocystis pneumonia, appropriate prophylaxis especially, pneumocystis jirovecii <, logistic regression analysis, past immunosuppressant use, odds ratio 1, 16 – 1, underlying autoimmune disease, identify risk factors, past steroid dose, associated lower mortality, term steroid use |
| الوصف: | Objective Long-term steroid use increases the risk of developing Pneumocystis pneumonia (PcP), but there are limited reports on the relation of long-term steroid and PcP mortality. Methods Retrospective multicenter study to identify risk factors for PcP mortality, including average steroid dose before the first visit for PcP in non-human immunodeficiency virus (HIV)-PcP patients. We generated receiver operating characteristic (ROC) curves for 90-day all-cause mortality and the mean daily steroid dose per unit body weight in the preceding 10 to 90 days in 10-day increments. Patients were dichotomized by 90-day mortality and propensity score-based stabilized inverse probability of treatment weighting (IPTW) adjusted covariates of age, sex, and underlying disease. Multivariate analysis with logistic regression assessed whether long-term corticosteroid use affected outcome. Results Of 133 patients with non-HIV-PcP, 37 died within 90 days of initial diagnosis. The area under the ROC curve for 1–40 days was highest, and the optimal cutoff point of median adjunctive corticosteroid dosage was 0.34 mg/kg/day. Past steroid dose, underlying interstitial lung disease and emphysema, lower serum albumin and lower lymphocyte count, higher lactate dehydrogenase, use of therapeutic pentamidine and therapeutic high-dose steroids were all significantly associated with mortality. Underlying autoimmune disease, past immunosuppressant use, and a longer time from onset to start of treatment, were associated lower mortality. Logistic regression analysis after adjusting for age, sex, and underlying disease with IPTW revealed that steroid dose 1–40 days before the first visit for PcP (per 0.1 mg/kg/day increment, odds ratio 1.36 [95% confidence interval = 1.16–1.66], P <0.001), low lymphocyte counts, and high lactate dehydrogenase revel were independent mortality risk factor, while respiratory failure, early steroid, and sulfamethoxazole/trimethoprim for PcP treatment did not. Conclusion A steroid dose before PcP onset was strongly ... |
| نوع الوثيقة: | still image |
| اللغة: | unknown |
| العلاقة: | https://figshare.com/articles/figure/Patient_selection_flowchart_/25191817Test |
| DOI: | 10.1371/journal.pone.0292507.g001 |
| الإتاحة: | https://doi.org/10.1371/journal.pone.0292507.g001Test https://figshare.com/articles/figure/Patient_selection_flowchart_/25191817Test |
| حقوق: | CC BY 4.0 |
| رقم الانضمام: | edsbas.2D61ADAB |
| قاعدة البيانات: | BASE |
| DOI: | 10.1371/journal.pone.0292507.g001 |
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