FRI0239 HIGHER DOSE OF ADJUNCTIVE GLUCOCORTICOID THERAPY IS ASSOCIATED WITH MORTALITY OF PNEUMOCYSTIS PNEUMONIA IN PATIENTS WITH RHEUMATIC DISEASES
Authors: Yi-Min Huang, Chiao-Feng Cheng, Cheng-Hsun Lu, Chieh-Yu Shen, LI Ko-Jen, Jung-Yien Chien, Song-Chou Hsieh, Po-Ren Hsueh
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Pneumocystis pneumonia (PCP) is a fatal complication in patients with rheumatic diseases, and prognostic factors are not well recognized.<sup>1</sup> Adjunctive glucocorticoid therapy is beneficial for PCP in patients with acquired immunodeficiency syndrome, but the role in patients with rheumatic diseases is debated.<sup>2</sup> <h3>Objectives</h3> To investigate the prognostic factors of PCP in patients with rheumatic diseases. <h3>Methods</h3> 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 <i>Pneumocystis jirovecii</i> 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. <h3>Results</h3> 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 (<i>p</i>=0.016), an older age (<i>p</i>=0.017), and a higher CXR radiographic score (<i>p</i>=0.029). In multivariate analysis, independent predictors of mortality were increased glucocorticoid dose (&gt;10mg/day) as adjunctive therapy (odds ratio, OR=5.58, 95% confidence interval, C.I.=1.09-28.62; <i>p</i>=0.039), age (OR=1.06, 95% C.I.=1.00-1.11; <i>p</i>=0.037), and CXR radiographic score (OR=1.21, 95% C.I.=1.00-1.47, <i>p</i>=0.048). <h3>Conclusion</h3> Increased glucocorticoid dose (&gt;10mg/day) as adjunctive therapy, older age, and CXR radiographic score were independently prognostic factors of mortality in PCP patients with rheumatic diseases. <h3>Disclosure of Interest</h3> None declared <h3>References</h3> [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. <h3>Disclosure of Interests</h3> None declared