Independent risk of mechanical ventilation for AIDS-related Pneumocystis carinii pneumonia associated with bronchoalveolar lavage neutrophilia

The use of mechanical ventilation (MV) for AIDS-related Pneumocystis carinii pneumonia (PCP) has varied overtime. The introduction of adjunctive cor ticosteroic; therapy has changed the patophysiology of PCR In the present study, we attempted to identify factors predictive of severe respiratory failure requiring MV amongst patients with PCP treated in the era of adjunctive corticosteroid therapy Furthermore, we studied factors associated with survival in relation to MV Of 170 consecutive patients with AIDS-related PCR 18 (11%) required MV Thirteen of 18 ventilated patients died (72%). In a logistic regression analysis, higher age, increased brnchooalveolar lavage (BAL) neutrophilia and a positive BAL cyto megalovirus CMV culture were associated with the need of MV In multivariate analyses, only BAL neutrophilia remained independently predictive of mechanica ventilation. In conclusion, short-term mortality remained high after the introduction of adjunctive corticosteroid therapy BAL neutrophilia may be a useful prognostic marker to identify patients at high risk of requiring mechanical ventilation. (C) 2001 Harcourt Publishers Ltd.