P-2287. Are Solid Organ Transplant or Hematopoietic Stem Cell Transplant Recipients at Greater Risks of Unfavorable Outcomes of <i>Pneumocystis</i> Pneumonia?
Bibliographic record
Abstract
Abstract Background Solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients with Pneumocystis pneumonia (PCP) appear to be at risks of adverse outcomes and mortality with limited data. Methods In this retrospective cohort, we compared the PCP manifestations, including clinical presentation, laboratory data, imaging studies, treatment and outcomes between SOT and HSCT recipients diagnosed with PCP at University Health Network, Toronto, Canada, from January 2011 to January 2022. We measured a composite outcome including 21-day ICU admission and/or 28-day all-cause mortality following PCP diagnosis. Using multivariable logistic regression analysis, we estimated adjusted odds ratio (aOR) to determine the concurrent effects of covariates. Results During the accrual period, a total of 32 (55.2%) HSCT (20 allogeneic, 11 autologous, and one cord-blood transplant recipients) and 26 (44.2%) SOT (10 kidney, 8 liver, 5 lung, and 3 heart recipients) fulfilled the PCP diagnosis criteria. Notably, chronic steroid treatment was more common in SOT than in HSCT recipients [24 (92.3%) vs 13 (40.6%), p = 0.001]. The median time of post-transplant PCP diagnosis was 488 days with interquartile range (IQR) 90-481 in the HSCT group, and 1,453 (IQR 38-3,909) days in the SOT group. In comparison, dyspnea [25 (96.2%) vs 23 (71.9%), p = 0.015], desaturation [16 (72.7%) vs 12 (38.7%), p = 0.015], and pleural effusion [8 (30.8%) vs 2 (6.3%), p = 0.014] were more frequent in the SOT group. We observed a higher fungal load [11,450 (IQR 2,207-191,750) vs 10,295 (IQR 2,405-21,325) copies/mL, p = 0.043] and occurrence of the composite outcomes [13 (50%) vs 3 (9.4%), p = 0.001) in the SOT than the HSCT group. In the multivariable analysis, SOT recipients (aOR 7.1, IQR 1.3-37.4), patients received chronic steroid treatment (aOR 1.3, IQR 0.2-6.6), required supplemental O2 at the initial presentation (aOR 1.8, IQR 0.3-10.4), and had pleural effusion (OR 10.4, IQR 1.5-70.8) were significantly at the risk of composite outcome. Conclusion SOT recipients appear to be at a greater risk of ICU admission and mortality than HSCT recipients. SOT or HSCT recipients with pleural effusion or requiring supplemental O2 on admission, particularly if receiving chronic steroid therapy, are particularly at risk of severe outcomes. Disclosures All Authors: No reported disclosures
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
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".