ArticleBMC infectious diseases2026
Predictors and mortality in PCR-positive pneumocystis pneumonia among non-HIV patients.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPneumocystis jirovecii is a major cause of morbidity and mortality in HIV. It also poses a significant risk to non-HIV immunocompromised patients, especially those with cancer or recent chemotherapy. We evaluated risk factors, diagnostic markers-including lactate dehydrogenase (LDH)-and mortality predictors in PCR-confirmed pneumocystis pneumonia (PJP).
methodsWe retrospectively analyzed patients with hypoxemia, pulmonary involvement and/or fever who underwent PJP PCR testing at Koç University Hospital between January 2020 and November 2023. Cases were defined as patients with a positive PCR result who fulfilled the EORTC/MSGERC criteria for PJP, whereas the non-PJP group included PCR-negative patients and PCR-positive patients without clinically compatible disease. Clinical, laboratory, and radiologic data-including LDH, fungal load, co-infections, and 4-week mortality-were collected.
resultsOf 235 patients, 59 had PCR-confirmed PJP. PJP patients were older (median 70 vs. 64.5, p < 0.001), more often had solid organ malignancies (67.8% vs. 41.5%, p < 0.001), recent chemotherapy (66.1% vs. 41.5%, p = 0.001), and higher fungal loads (median 10,892 vs. 0, p < 0.001). Bilateral lung lesions (81% vs. 66.5%, p = 0.037) and ground-glass opacities (82.8% vs. 67.7%, p = 0.041) were more frequent. Serum LDH increased by 81.6% in PJP vs. 20.7% in controls (p = 0.001), whereas no significant difference was observed among patients with elevated baseline LDH (29.7% vs. 16.3%, p = 0.397). Multivariate analysis identified older age (OR 1.042, p = 0.017), solid organ malignancy (OR 2.304, p = 0.048), and CMV co-infection (OR 3.786, p = 0.006) as independent factors associated with PJP, whereas ICU admission at diagnosis was inversely associated with PJP (OR 0.239, p = 0.005). The 4-week mortality was 37%, with bacterial co-infection as the strongest predictor (OR 5.854, p = 0.009).
conclusionOlder age, solid organ malignancy, and CMV co-infection increased PJP risk, while bacterial co-infection predicted mortality. LDH changes supported diagnosis, but not when baseline levels were already elevated, in this predominantly oncology cohort.
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