P.137: Which immunodeficiency status has greater risks of poor pneumocystic pneumonia outcomes than other immunocompromised populations?
Bibliographic record
Abstract
Introduction: There has been limited data in comparison of Pneumocystis pneumonia (PCP) outcomes and course of illness among non-HIV immunocompromised cohorts. This study aims to assess the manifestations and outcomes of PCP in diverse immunocompromised populations. The findings may be helpful for identifying risk factors of destructive consequences in this life-threatening fungal infection. Methods: We retrospectively reviewed and collected data including clinical presentations, course of illness, comorbidities, laboratory data, imaging studies, and treatment of patients diagnosed with PCP at University Health Network, Toronto, Canada, from January 1, 2011, to December 31, 2021. The study outcome was a composite variable including 21-day ICU admission and/or 28-day all-cause mortality following PCP diagnosis. Risk factors of the composite outcomes were preliminarily identified by univariate analysis methods, then we used multivariable logistic regression analysis and estimated adjusted OR (aOR) to determine the concurrent effects of covariates. Results: During the specific time frame, a total of 182 immunocompromised patients including 19 (10.4%) HIV infection, 54 (29.7%) hematologic malignancies, 32 (17.6%) hematopoietic stem cell transplantation, 33 (18.1%) solid tumors, 26 (14.3%) solid organ transplantation, 12 (6.6%) autoimmune diseases, and 6 (3.3%) other immunosuppressive conditions fullfilled the PCP diagnostic criteria. The median age was 59.5 (interquartile range [IQR], 45.5-69.5 years) with 112 male (61.5%). 83 (45.6%) of them were on chronic steroid treatment at diagnosis. Prolonged (4 weeks at the minimum) lymphopenia and neutropenia were present in 115 (64.6%) and 27 (15.2%) patients, respectively. Overall, 44/182 patients (24.2%) developed composite outcomes with 39 ICU admissions (21.4%) and 17 (9.3%) deaths. In univariate analysis, significant risk factors were SOT [13 (29.5%) vs 13 (9.4%), p < 0.001], chronic liver disease [15 (34.1%) vs 9 (6.5%), p < 0.001], prolonged lymphopenia [37 (84.1%) vs 78 (56.5%), p < 0.001], hypoxemia [24 (54.5%) vs 55 (39.9%), p = 0.037], pulmonary nodules [18 (40.9%) vs 95 (68.8%), p = 0.001], and pleural effusion [14 (31.8%) vs 13 (9.4%), p < 0.001]. Finally, SOT (aOR 3.8, IQR 1.1-13.8), prolonged lymphopenia (aOR 8.8, IQR 2.1-37.4), and chronic liver disease (aOR 6.3, IQR 1.8-22.2) were statistically significant predictive variables of the composite outcomes from multivariate analysis. Conclusions: SOT recipients appear to be at a greater risk of combined ICU admission and mortality outcomes compared to other non-SOT immunocompromised patients infected with PCP. Prolonged lymphopenia and chronic liver disease were also correlated with unfavorable composite outcomes in these cohorts.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".