Impact of early therapeutic modality on 28-day mortality in immunocompromised patients with opportunistic pulmonary infections: a multicenter retrospective study
Shiying Guo, Linlin Wang, Jinfang Shi, Xiaoyan Sai, Suping Tang, Jiajia Wang, Anqi Wang, Dong Qiu, Shuguang Han, Yan Wu, Cheng ChenBackground:
Opportunistic pulmonary infections remain a significant threat in immunocompromised cases.
Objectives:
This study aims to evaluate the impact of early therapeutic modalities on 28-day mortality in non-AIDS and non-solid tumor immunocompromised patients hospitalized with opportunistic pulmonary infections, and to identify associated prognostic factors.
Design:
This multicenter retrospective study enrolled immunocompromised patients with opportunistic pulmonary infections from four respiratory centers between January 2022 and December 2024 to delineate their clinical characteristics and prognostic factors. The 28-day mortality was defined as the primary clinical outcome.
Methods:
Multivariate logistic analysis was utilized to identify the independent prognostic factors for 28-day mortality. Moreover, a predictive nomogram was constructed and validated.
Results:
A total of 127 patients were included. Differences in pathogen distribution, laboratory tests at admission, and treatment strategies were identified between survivors and non-survivors. A multivariate analysis suggested that longer time from onset to pathogen-targeted therapy (OR: 1.047, 95% CI: 1.004–1.091,
Conclusion:
Early recognition, timely targeted antimicrobial therapy, and minimized glucocorticoid use are crucial to immunocompromised subjects suffering opportunistic pulmonary infections, which could prevent the escalation to ETI-IMV and septic shock, thereby reducing mortality.