Radiological predictors of PCP in HIV-positive adults in South Africa: A matched case-control study
Background: Definition of chest X-ray (CXR) features associated with laboratory-confirmed pneumocystis pneumonia (PCP) among HIV-positive adults is needed to improve diagnosis in high-burden settings. Objectives: Our primary objective was to identify CXR features associated with confirmed PCP diagn...
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| Format: | Article |
| Language: | English |
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AOSIS
2024-11-01
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| Series: | Southern African Journal of HIV Medicine |
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| Online Access: | https://sajhivmed.org.za/index.php/hivmed/article/view/1636 |
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| author | Nicola K. Wills Jared Tavares Qonita Said-Hartley Sean Wasserman |
| author_facet | Nicola K. Wills Jared Tavares Qonita Said-Hartley Sean Wasserman |
| author_sort | Nicola K. Wills |
| collection | DOAJ |
| description | Background: Definition of chest X-ray (CXR) features associated with laboratory-confirmed pneumocystis pneumonia (PCP) among HIV-positive adults is needed to improve diagnosis in high-burden settings.
Objectives: Our primary objective was to identify CXR features associated with confirmed PCP diagnosis and severe PCP (defined by hypoxia, intensive care unit referral/admission, and/or in-hospital death). We also explored the performance of logistic regression models, incorporating selected clinical and CXR predictors, for PCP diagnosis and severe PCP.
Method: We conducted a case-control study involving HIV-positive adults with laboratory-confirmed PCP and a matched cohort with non-PCP respiratory presentations at regional hospitals in Cape Town, South Africa (2012–2020).
Results: Records from 104 adults (52 PCP cases and 52 non-PCP controls) were included. Diffuse versus patchy ground-glass opacification was associated with increased odds of PCP diagnosis (adjusted odds ratio [aOR]: 6.2, 95% confidence interval [CI]: 1.6–28.9, P = 0.01) and severe PCP (aOR: 4.5, 95% CI: 1.6–14.4, P = 0.008). Consolidation was associated with severe PCP (aOR: 3.3, 95% CI: 1.2–11.0, P = 0.03) as was increasing ground-glass zone involvement (aOR: 2.1 for each one-unit increase in involved zone; 95% CI: 1.4–3.2, P = 0.0004). Models incorporating hypoxia (hypoxia model) or tachypnoea (respiratory rate model) with diffuse ground-glass opacities, absence of pleural effusion or reticular/reticulonodular changes on CXR performed well in predicting PCP (area under the receiver operating characteristic curve 0.828 [hypoxia model] and 0.857 [respiratory rate model]).
Conclusion: CXR evaluation alongside bedside clinical information offers good accuracy for discriminating definite PCP from other HIV-associated respiratory diseases. |
| format | Article |
| id | doaj-art-c5cb3eb2ef544d269cef6d8ab0fa6470 |
| institution | Kabale University |
| issn | 1608-9693 2078-6751 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | AOSIS |
| record_format | Article |
| series | Southern African Journal of HIV Medicine |
| spelling | doaj-art-c5cb3eb2ef544d269cef6d8ab0fa64702024-12-03T11:30:41ZengAOSISSouthern African Journal of HIV Medicine1608-96932078-67512024-11-01251e1e1010.4102/sajhivmed.v25i1.1636878Radiological predictors of PCP in HIV-positive adults in South Africa: A matched case-control studyNicola K. Wills0Jared Tavares1Qonita Said-Hartley2Sean Wasserman3Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape TownDepartment of Statistics, Faculty of Science, University of Cape Town, Cape TownDepartment of Radiology, Faculty of Health Sciences, University of Cape Town, Cape TownInstitute for Infection and Immunity, St George’s University of London, London, United Kingdom; Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; and MRC Centre for Medical Mycology, Faculty of Health and Life Sciences, University of Exeter, ExeterBackground: Definition of chest X-ray (CXR) features associated with laboratory-confirmed pneumocystis pneumonia (PCP) among HIV-positive adults is needed to improve diagnosis in high-burden settings. Objectives: Our primary objective was to identify CXR features associated with confirmed PCP diagnosis and severe PCP (defined by hypoxia, intensive care unit referral/admission, and/or in-hospital death). We also explored the performance of logistic regression models, incorporating selected clinical and CXR predictors, for PCP diagnosis and severe PCP. Method: We conducted a case-control study involving HIV-positive adults with laboratory-confirmed PCP and a matched cohort with non-PCP respiratory presentations at regional hospitals in Cape Town, South Africa (2012–2020). Results: Records from 104 adults (52 PCP cases and 52 non-PCP controls) were included. Diffuse versus patchy ground-glass opacification was associated with increased odds of PCP diagnosis (adjusted odds ratio [aOR]: 6.2, 95% confidence interval [CI]: 1.6–28.9, P = 0.01) and severe PCP (aOR: 4.5, 95% CI: 1.6–14.4, P = 0.008). Consolidation was associated with severe PCP (aOR: 3.3, 95% CI: 1.2–11.0, P = 0.03) as was increasing ground-glass zone involvement (aOR: 2.1 for each one-unit increase in involved zone; 95% CI: 1.4–3.2, P = 0.0004). Models incorporating hypoxia (hypoxia model) or tachypnoea (respiratory rate model) with diffuse ground-glass opacities, absence of pleural effusion or reticular/reticulonodular changes on CXR performed well in predicting PCP (area under the receiver operating characteristic curve 0.828 [hypoxia model] and 0.857 [respiratory rate model]). Conclusion: CXR evaluation alongside bedside clinical information offers good accuracy for discriminating definite PCP from other HIV-associated respiratory diseases.https://sajhivmed.org.za/index.php/hivmed/article/view/1636hivpcppneumocystis jiroveciichest x-rayprediction rule |
| spellingShingle | Nicola K. Wills Jared Tavares Qonita Said-Hartley Sean Wasserman Radiological predictors of PCP in HIV-positive adults in South Africa: A matched case-control study Southern African Journal of HIV Medicine hiv pcp pneumocystis jirovecii chest x-ray prediction rule |
| title | Radiological predictors of PCP in HIV-positive adults in South Africa: A matched case-control study |
| title_full | Radiological predictors of PCP in HIV-positive adults in South Africa: A matched case-control study |
| title_fullStr | Radiological predictors of PCP in HIV-positive adults in South Africa: A matched case-control study |
| title_full_unstemmed | Radiological predictors of PCP in HIV-positive adults in South Africa: A matched case-control study |
| title_short | Radiological predictors of PCP in HIV-positive adults in South Africa: A matched case-control study |
| title_sort | radiological predictors of pcp in hiv positive adults in south africa a matched case control study |
| topic | hiv pcp pneumocystis jirovecii chest x-ray prediction rule |
| url | https://sajhivmed.org.za/index.php/hivmed/article/view/1636 |
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