FRI0239\u2005HIGHER DOSE OF ADJUNCTIVE GLUCOCORTICOID THERAPY IS ASSOCIATED WITH MORTALITY OF PNEUMOCYSTIS PNEUMONIA IN PATIENTS WITH RHEUMATIC DISEASES

Abstract

Background Pneumocystis pneumonia (PCP) is a fatal complication in patients with rheumatic diseases, and prognostic factors are not well recognized.1 Adjunctive glucocorticoid therapy is beneficial for PCP in patients with acquired immunodeficiency syndrome, but the role in patients with rheumatic diseases is debated.2 Objectives To investigate the prognostic factors of PCP in patients with rheumatic diseases. Methods Retrospective data was collected for all subjects with rheumatic diseases and PCP between October 2015 and October 2018 in a tertiary referral center. PCP was diagnosed via a positive sputum Pneumocystis jirovecii PCR in the presence of a compatible clinical presentation. The clinical characteristic, underlying rheumatic diseases, comorbidity, immunosuppressants, adjunctive glucocorticoid dose, and outcome were evaluated. Chest X-ray (CXR) was evaluated as a radiographic score (0-18), and a higher score suggested a more severe lung involvement. The prognostic factors of mortality were analyzed by multivariate logistic regression analysis. Results 40 patients with PCP and rheumatic diseases were included. The mean age of the patients was 55.7 years, and twenty (50%) were female. The underlying rheumatic diseases were systemic lupus erythematosus (30%), rheumatoid arthritis (22.5%), Sjögren’s syndrome (12.5%), systemic vasculitis (12.5%), antiphospholipid syndrome (10%), idiopathic inflammatory myopathies (10%), undifferentiated connective tissue disease (7.5%), and psoriatic arthritis (2.5%). All subjects were separated into survivors (n=17) and non-survivors (n=23) groups. The overall in-hospital mortality rate was 57.5%. The group of non-survivors had a higher adjunctive glucocorticoid dose (p=0.016), an older age (p=0.017), and a higher CXR radiographic score (p=0.029). In multivariate analysis, independent predictors of mortality were increased glucocorticoid dose (>10mg/day) as adjunctive therapy (odds ratio, OR=5.58, 95% confidence interval, C.I.=1.09-28.62; p=0.039), age (OR=1.06, 95% C.I.=1.00-1.11; p=0.037), and CXR radiographic score (OR=1.21, 95% C.I.=1.00-1.47, p=0.048). Conclusion Increased glucocorticoid dose (>10mg/day) as adjunctive therapy, older age, and CXR radiographic score were independently prognostic factors of mortality in PCP patients with rheumatic diseases. Disclosure of Interest None declared References [1] Teichtahl AJ, Morrisroe K, Ciciriello S, et al. Pneumocystis jirovecii pneumonia in connective tissue diseases: Comparison with other immunocompromised patients. Semin Arthritis Rheum 2015;45:86–90. [2] Ando T, Abe Y, Endo Y, et al. Rapid glucocorticoid tapering therapy to reduce mortality from pneumocystis pneumonia in patients with rheumatic disease. Mod Rheumatol 2018;13:1–6. Disclosure of Interests None declared