Clinical characteristics and prognosis of severe pneumocystis carinii pneumonia in pediatric liver transplant recipients
10.3760/cma.j.issn.1673-4912.2022.09.008
- VernacularTitle:儿童肝移植术后重症耶氏肺孢子菌肺炎特征和预后分析
- Author:
Juan QIAN
1
;
Kang AN
;
Fang ZHANG
;
Botao NING
;
Jian ZHANG
;
Hong REN
;
Biru LI
;
Qiushi YANG
Author Information
1. 上海交通大学医学院附属上海儿童医学中心重症医学科 200127
- Keywords:
Child;
Pneumocystis carinii pneumonia;
Liver transplant;
Critical care
- From:
Chinese Pediatric Emergency Medicine
2022;29(9):701-706
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical characteristics and risk factors for mortality of severe pneumocystis carinii pneumonia(PCP)in pediatric liver transplant(LT)recipients.Methods:The data of severe PCP in LT recipients diagnosed at Shanghai Children′s Medical Center from November 2019 to February 2021 were collected.The clinical characteristics and risk factors for 28-day mortality were analyzed.Results:Fifteen patients were enrolled in the study.Thirteen cases survived and 2 cases were non-survived.There was no routine anti-pneumocystis prophylaxis after LT.The median age of onset of PCP was 12(7, 26)months.The median time after LT was 3.00(0.33, 4.00)months.The onset clustered in November-December and June-August.All patients were mechanically ventilated, and some patients were given prone ventilation(11 cases), neuromuscular blocking agents(13 cases)and high concentration oxygen(more than 60%, nine cases). Fourteen cases were complicated with other infections.Two cases were complicated with pneumothorax and subcutaneous/mediastinal emphysema.There were 2 cases with septic shock-like manifestation, 1 case of right heart insufficiency, 1 case of right heart failure(death), and 1 case of multiple organ failure(death). Compared with the survived group, the non-survived group had higher pediatric risk of mortality Ⅲ score[3.5(0.0, 6.0)vs.8.5(5.0, 12.0), Z=1.993, P=0.046] and lactate dehydrogenase level[1 731.5(1 012.0, 3 270.0)U/L vs.4 387.5(3 606.0, 5 169.0)U/L, Z=2.148, P=0.032]. Conclusion:PCP in pediatric LT is critical and complicated.Pediatric risk of mortality Ⅲ scores and lactate dehydrogenase increase in 28-day hospitalized deaths.
