Prognostic impact and safety of early adjunctive corticosteroid therapy in HIV-negative severe pneumocystis pneumonia: a propensity-matched multicentre study

作者：Florian Reizine, Vicky Stiegler, Romain Lécuyer, Benoît Tessoulin, Guillaume Rieul, Fabrice Camou, Florent Morio, Anne Cady, Frédéric Gabriel, Emmanuel Canet, F. Raffi, David Boutoille, Nahéma Issa, Benjamin Gaborit · 发表于：Thorax · 年份：2025 · DOI：10.1136/thorax-2025-223504 · 被引用次数：3 · 研究领域：Pneumocystis jirovecii pneumonia detection and treatment、Pneumonia and Respiratory Infections、HIV/AIDS drug development and treatment

BACKGROUND: pneumonia (PcP) in HIV-negative patients is associated with high mortality rates. While early adjunctive corticosteroid (AC) therapy benefits HIV-positive patients with severe PcP, its efficacy and safety in HIV-negative patients remain poorly investigated. METHODS: This multicentre retrospective observational study included consecutive patients diagnosed with proven or probable PcP, from January 2011 to January 2021. This study assessed the prognostic impact and safety of early AC in HIV-negative patients with PcP. To address baseline characteristic imbalances between patients, a non-parsimonious propensity matching analysis was performed with a 1/1 ratio. Survival analysis, day-90 mortality rate and healthcare-associated infections (HCAI) were compared using Cox and logistic regressions. RESULTS: ) ratio was 224 (114-229). The 90-day mortality rate was 29.4% (103/350). There was no significant difference in 90-day mortality according to AC, both in overall and matched populations (OR 1.27 (0.78-2.05); p=0.336 and 0.92 (0.52-1.62); p=0.772, respectively). HCAI incidences appeared similar between groups. In the matched population, a higher proportion of AC patients required high-flow oxygen therapy (OR 2.15 (1.17-4.05); p=0.015) and mechanical ventilation duration was higher in corticosteroid recipients (OR 1.04 (1.01-1.09); p=0.048). CONCLUSION: Early AC therapy was not associated with reduced 90-day mortality in HIV-negative PcP patients. Although recommended in...