Table 1 Clinical characters, treatments and outcomes of PNS patients with PCP (n=18)
Variables
|
Patients (n=18)
|
Male (n, %)
|
10 (55.6)
|
Age (years)
|
48.5±15.9
|
PNS duration (months)
|
4.8±3.9
|
Histological subtype
|
|
MN (n, %)
|
7(38.9)
|
IgA nephropathy (n, %)
|
6(33.3)
|
MCD (n, %)
|
5(27.8)
|
Duration of prednisone (months)
Prednisone usage (n, %)
aOther immunosuppressive therapy
|
3.7±1.6
18(100)
14(77.8)
|
bComorbidities
|
7(38.9)
|
Interval between onset and diagnosis (days)
|
5.6±4.2
|
Fever (n, %)
|
18(100)
|
Cough (n, %)
|
13(72.2)
|
Sputum (n, %)
|
12(66.7)
|
Dyspnea (n, %)
|
12(66.7)
|
PaO2 on admission(mmHg)
|
59.5±12.3
|
Coexisting infection (n, %)
|
8(44.4)
|
Cytomegalovirus (n, %)
|
4(22.2)
|
Bacteremia (n, %)
|
2(11.1)
|
Invasive aspergillosis (n, %)
|
1(5.6)
|
Mycobacterium tuberculosis (n, %)
|
1(5.6)
|
WBC(cell/mm3)
|
10800±3200
|
Leukomonocyte (cell/mm3)
|
1020±350
|
Hemoglobin (g/L)
|
103.8±19.1
|
Urine protein (g/24h)
Serum creatinine (µmol/L)
Albumin (g/L)
|
3.1(0-10.1)
112.2±59.9
25.2±4.8
|
ESR(mm/h)
|
50.1±10.2
|
CRP(mg/L)
|
114.3±89.9
|
LDH(U/L)
|
689.7±281.2
|
CD4+ cell count (cells/mm3)
|
281.4±128.2
|
IgG (g/L)
|
5.9±1.6
|
Radiographic findings
Ground glass opacities (n, %)
|
17(94.4)
|
Bilateral symmetric (n, %)
|
15(83.3)
|
Treatments
TMP/SMZ (n, %)
|
18(100)
|
Steroid (n, %)
|
12(66.7)
|
Caspofungin (n, %)
|
11(61.1)
|
ICU admission (n, %)
|
11(61.1)
|
Mechanical ventilation (n, %)
|
9(50)
|
Outcomes
Survivor (n, %)
Non-survivors (n, %)
|
18(100)
0(0)
|
Data are shown as mean ± SD, median (range), or n (%).
PNS: primary nephrotic syndrome, PCP: pneumocystis pneumonia, MN: membranous nephropathy, MCD: minimal change disease, PaO2: arterial partial pressure of oxygen, WBC: white blood cells, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, LDH: lactate dehydrogenase, IgG: immunoglobulin G, TMP/SMZ: trimethoprim/sulfamethoxazole, ICU: intensive care unit.
aIncluding CTX: cyclophosphamide, MMF: mycophenolate mofetil, Cyclosporin A, Tacrolimus, and Rituximab.
bIncluding chronic pulmonary disease, diabetes, heart disease and malignancy.
Table 2 Possible risk factors of PNS patients with PCP
Variables
|
PCP (n=18)
|
No infection (n=180)
|
P-value
|
Male (n, %)
|
10 (55.6)
|
108 (60)
|
0.803
|
Age (years)
|
48.5±15.9
|
49.2±17.3
|
0.760
|
PNS duration (months)
|
4.8±3.9
|
6.7(0.1-108)
|
0.605
|
Histological subtype
|
|
|
0.079
|
MN (n, %)
|
7(38.9)
|
108(60)
|
|
IgA nephropathy (n, %)
|
6(33.3)
|
21(11.7)
|
|
MCD (n, %)
|
5(27.8)
|
39(21.7)
|
|
FSGS (n, %)
|
0(0)
|
10(5.5)
|
|
MPGN (n, %)
|
0(0)
|
2(1.1)
|
|
Prednisone usage (n, %)
Duration of prednisone (months)
Methylprednisolone pulse therapy (n, %)
Cumulative prednisolone dose (g)
Initial dose of prednisone (mg/d)
Other immunosuppressive therapy (n, %)
CTX (n, %)
MMF (n, %)
Cyclosporin A or Tacrolimus (n, %)
Rituximab (n, %)
|
18(100)
3.7±1.6
2(11.1)
2.5±1.7
52.4(0-600)
14(77.8)
5(27.8)
4(22.2)
5(27.8)
0(0)
|
110(61.1)
4.5±3.1
17(9.4)
1.6±1.1
42,1(0-600)
80(32.9)
27(33.8)
26(32.5)
34(42.5)
2(2.5)
|
<0.001
0.143
0.685
0.025
0.215
<0.001
0.783
0.573
0.296
1.000
|
Comorbidities
|
|
|
0.305
|
Chronic pulmonary disease (n, %)
|
1(5.5)
|
8(4.4)
|
|
Diabetes (n, %)
|
5(27.8)
|
20(11.1)
|
|
Heart disease (n, %)
|
2(11.1)
|
15(8.3)
|
|
Malignancy (n, %)
|
0(0)
|
2(1.1)
|
|
Urine protein (g/24h)
Serum creatinine (µmol/L)
Albumin (g/L)
Leukomonocyte (cell/mm3)
|
3.1(0-10.1)
112.2±59.9
25.2±4.8
990±350
|
4.1±2.8
81.2±35.3
24.9±8.6
1240±420
|
0.141
0.001
0.887
0.033
|
CD4+ cell count (cells/mm3)
|
281.4±128.2
|
788.7±377.2
|
<0.001
|
Hemoglobin (g/L)
|
103.8±19.1
|
121.4±20.4
|
0.004
|
IgG (g/L)
|
5.9±1.6
|
6.9±2.6
|
0.165
|
Data are shown as mean ± SD, median (range), or n (%).
PNS: primary nephrotic syndrome, PCP: pneumocystis pneumonia, MN: membranous nephropathy, MCD: minimal change disease, FSGS: focal segmental glomerulosclerosis, MPGN: mesangioproliferative glomerulonephritis, CTX: cyclophosphamide, MMF: mycophenolate mofetil, WBC: white blood cell, IgG: immunoglobulin G.
Table 3 Binary logistic regression analysis with PCP as the dependent variable (R2 =0.702)
Variable
|
B
|
SE
|
P-value
|
OR
|
95% CI for OR
|
Prednisone usage
|
1.33
|
0.37
|
0.002
|
3.39
|
0.91-12.13
|
CD4+ cell count
|
-2.97
|
1.13
|
0.021
|
0.64
|
0.04-2.14
|
PCP: pneumocystis pneumonia, B: partial regression coefficients, SE: standard error, OR: odds ratios, CI: confidence interval.