Admission CRP-to-albumin ratio predicts the 180-day mortality of acquired immunodeficiency syndrome-related pneumocystis pneumonia

Background: Assessment tools are necessary for the adequate stratification of patients with acquired immunodeficiency syndrome (AIDS)-related pneumocystis pneumonia (PCP).

Aim: To evaluate the ability of severity assessment scores and inflammation- and nutrition-based parameters for predicting the 180-day mortality of AIDS-related PCP.

Methods: This was a retrospective cohort study of patients with AIDS-related PCP admitted at the Beijing Di-Tan Hospital. The CURB-65 score, Pneumonia Severity Index (PSI) score, Acute Physiology And Chronic Health Evaluation II (APACHE II) score, C-reactive protein (CRP)-to-albumin ratio (CAR), procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) during the first 24 hours of intensive care unit (ICU) admission were analyzed. The prognostic values of the severity assessment scores and biomarkers for 180-day mortality were evaluated using receiver operating characteristic (ROC) curves and integrated discrimination improvement (IDI) indexes.

Results: A total of 123 patients with AIDS-related PCP were included. Fifty-five patients were dead, and 68 were still alive at 180 days after admission. CAR, CURB-65, PSI, and APACHE II were independent predictors of 180-day mortality. The optimal cut-off value of CAR was 2.0 mg/g (area under the ROC curve [AUC]=0.844, 95% CI: 0.776, 0.913), and CAR >2.0 mg/g increased the prognostic value of all three severity assessment scores, with an IDI index of 5.1% for the CURB-65 score, 8.1% for the PSI score, and 4.1% for the APACHE II score (all P<0.05).

Conclusion: Combining CAR >2.0 mg/g enhanced the capability of CURB-65, APACHE II, and PSI in predicting the 180-day mortality of patients with AIDS-related PCP.