Impact pronostique de la corticothérapie adjuvante précoce dans la pneumpathie à Pneumocystis Jirovecii du patient d'onco-hématologie non-VIH

Abstract : Introduction: While adjunctive corticosteroid therapy has been proven effective in HIV-patients with Pneumocystis Pneumoniae (PCP), data remains unclear and controversial concerning non-HIV related-patients. We evaluated the effects on mortality of early adjunctive corticosteroid therapy in non-HIV PCP-related patients. Material and methods: This retrospective cohort study included patients without HIV with PCP diagnosis admitted in Institut Paoli Calmette, a cancer referral centre, from January-1-2010 to december-31-2016. We compared 30-days and 1-year mortality rate, change in the respiratory item of the Sequential Organ Failure Assessment score (delta SOFA-resp), change in the global SOFA score (SOFA-aggravation) and use of intubation between day-1 and day-5 of anti-pneumocystis therapy and occurrence of coinfections between early adjunctive corticosteroid recipients within 48 hours (landmark analysis) and late or no corticosteroid recipients, using a naïve and Inverse Probability Weighted in survival analysis (IPW). Results: 133 HIV-negative patients with PCP were included (early corticosteroid n=88, late or no corticosteroid n=45). The main underlying conditions were haematological malignancies (n=107, 80,5%), solid tumor (n=27, 20,3%) and stem cell transplantation (n=17, 12,8%). Overall 30-days and 1-year mortality was respectively 24,1% and 58,2%. IPW analysis found no differences on 30-days (HR=1.45, 95% CI [0.7 - 3.04], p=0.321) and 1-year (HR=1.25, CI 95% [0.75 - 2.09], p=0.39) mortality rate between the both groups. In the same way, no differences in delta-SOFA-resp, SOFA-aggravation, use of intubation and occurrence of coinfections were found between the both groups. Conclusion: The addition of early adjunctive corticosteroid to anti-pneumocystis therapy in non-HIV patients with PCP was not associated with improved outcomes concerning 30-days and 1-year mortality and respiratory evolution. Further studies are needed to evaluated this therapeutic strategy.
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Mehdi Assal. Impact pronostique de la corticothérapie adjuvante précoce dans la pneumpathie à Pneumocystis Jirovecii du patient d'onco-hématologie non-VIH. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02095535⟩

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