Pneumocystis Pneumonia in Patients with Autoimmune Diseases: A Retrospective Study Focused on Clinical Characteristics and Prognostic Factors Related to Death

<div><p>Background</p><p>With the increasing use of immunosuppressive agents, the number of opportunistic infections has risen in patients with autoimmune diseases. Pneumocystis pneumonia (PCP) is one of these opportunistic infections that have a high mortality rate. However, only a few studies have described PCP in these patients, and these studies are limited in scope. We conducted this retrospective study to describe the clinical characteristics and factors associated with outcomes of PCP in patients with autoimmune diseases.</p><p>Methods</p><p>A retrospective study was performed in laboratory diagnosed PCP patients with autoimmune diseases in an academic hospital over a 10-year period. Patients with human immunodeficiency virus (HIV) infection were not included. Clinical characteristics were collected and the factors related to death were analysed.</p><p>Results</p><p>A total of 69 patients with PCP during the study period were included. Common clinical features included fever (81%), cough (56%), and dyspnea (35%). Ground glass opacity (81%) and reticulation (52%) were the most common radiological findings. Concurrent pulmonary infections including bacterium, aspergillus and cytomegalovirus were found in 34% of the patients. The overall in-hospital mortality rate was 32%. High mortality was associated with lower PaO₂/FiO₂ ratios and albumin levels. The lymphocyte count, CD4+ T cell count, previous usage of immunosuppressive agents, the duration and dose of glucocorticoids did not affect the outcome.</p><p>Conclusions</p><p>The mortality rate in PCP patients with autoimmune diseases is high. Low PaO₂/FiO₂ ratios and albumin levels are independent prognostic factors of mortality.</p></div

Demographical details, underlying diseases, and diagnostic procedures of the patients.

<p>* Vasculitis: Behcet’s disease, microscopic polyangiitis, granulomatosis with polyangiitis</p><p>** Other CTDs: Sjogren syndrome (SS), undifferentiated connective tissue disease (UCTD), mixed connective tissue disease, scleroderma</p><p># Immunosuppressive agents: cyclophosphamide, cyclosporin A, mycophenlatemofetil, and tripterygium glycosides</p><p>& Biological agents: ritaximab, and antitumor necrosis factor α(infliximab, entanercept)</p><p>Demographical details, underlying diseases, and diagnostic procedures of the patients.</p

Univariate analyses of risk factors among PCP patients determining survival rates.

<p>* Corticosteroids doses were expressed as the prednisolone equivalent dose</p><p>Univariate analyses of risk factors among PCP patients determining survival rates.</p

Clinical manifestations, Radiologic characters and laboratory findings of the patients.

<p>* Included <i>pseudomonas aeruginosa</i> in three specimens, <i>Acinetobacter baumannii</i> in one specimen, <i>Klebsiella pneumonia</i> in one specimen</p><p>Clinical manifestations, Radiologic characters and laboratory findings of the patients.</p

Kaplan-Meier survival curve for the patients with pneumocystis pneumonia.

<p>Kaplan-Meier survival curve for the patients with pneumocystis pneumonia.</p

DataSheet_1_Relationships between stable isotope natural abundances (δ13C and δ15N) and water use efficiency in rice under alternate wetting and drying irrigation in soils with high clay contents.pdf

Natural abundance of the stable isotope (δ13C and δ15N) in plants is widely used to indicate water use efficiency (WUE). However, soil water and texture properties may affect this relationship, which remains largely elusive. Therefore, the purpose of this study was to evaluate δ13C as affected by different combinations of alternate wetting and drying irrigation (AWD) with varied soil clay contents in different organs and whole plant and assess the feasibility of using δ13C and δ15N as a physiological indicator of whole-plant water use efficiency (WUEwhole-plant). Three AWD regimes, I100 (30 mm flooded when soil reached 100% saturation), I90 (30 mm flooded when reached 90% saturation) and I70 (30 mm flooded when reached 70% saturation) and three soil clay contents, 40% (S40), 50% (S50), and 60% (S60), were included. Observed variations in WUEwhole-plant did not conform to theoretical expectations of the organs δ13C (δ13Corgans) of plant biomass based on pooled data from all treatments. However, a positive relationship between δ13Cleaf and WUEET (dry biomass/evapotranspiration) was observed under I90 regime, whereas there were no significant relationships between δ13Corgans and WUEET under I100 or I70 regimes. Under I100, weak relationships between δ13Corgans and WUEET could be explained by (i) variation in C allocation patterns under different clay content, and (ii) relatively higher rate of panicle water loss, which was independent of stomatal regulation and photosynthesis. Under I70, weak relationships between δ13Corgans and WUEET could be ascribed to (i) bigger cracks induced by water-limited irrigation regime and high clay content soil, and (ii) damage caused by severe drought. In addition, a negative relationship was observed between WUEwhole-plant and shoot δ15N (δ15Nshoot) across the three irrigation treatments, indicating that WUEwhole-plant is tightly associated with N metabolism and N isotope discrimination in rice. Therefore, δ13C should be used cautiously as an indicator of rice WUEwhole-plant at different AWD regimes with high clay content, whereas δ15N could be considered an effective indicator of WUEwhole-plant.</p