Supplementary Role of Immunological Indicators in the Diagnosis and Prognosis of Pneumocystis Pneumonia in Non-HIV Immunocompromised Patients

Figures & data

Figure 1 The gating strategies of phenotype analysis of lymphocytes.

Table 1 Clinical Characteristics and Laboratory Indicators in PCP and Non-PCP Groups

	PCP	Non-PCP	P-value
Patients(n)	44	30
Demographics
Age (year, )	55.82±16.24	61±13.99	0.159
Male [n (%)]	25(56.82%)	19(63.33%)	0.575
Immunosuppressive conditions
Hematological malignancy [n (%)]	12(27.27%)	8(26.67%)	0.954
Solid tumor with chemotherapy [n (%)]	5(11.36%)	5(16.67%)	0.514
Autoimmune disease [n (%)]	27(61.36%)	17(56.67%)	0.686
Immunosuppressive therapies
Corticosteroids^a [n (%)]	35(79.55%)	18(60%)	0.067
Cyclophosphamide [n (%)]	5(11.36%)	3(10.0%)	1.000
Mycophenolate mofetil [n (%)]	4(9.09%)	2(6.67%)	1.000
Anticalcineurins [n (%)]	3(6.82%)	1(3.33%)	0.642
Anti-CD-20 agents [n (%)]	5(11.36%)	3(10.0%)	1.000
Anti-tumor chemotherapy [n (%)]	13(29.55%)	11(36.67%)	0.521
SOFA ()	3.84±2.88	4.24±3.25	0.582
Leukocytes (*10^9/L, )	8.67±3.93	8.13±4.08	0.574
Neutrophils (*10^9/L, )	7.31±3.35	6.65±3.75	0.437
Lymphocytes (*10^9/L, )	0.79±0.75	1.01±0.96	0.295
Monocytes (*10^9/L, )	0.42±0.62	0.4±0.23	0.863
Eosinophils [*10^9/L, M (Q1, Q3)]	0.01(0, 0.03)	0.01(0, 0.1)	0.588
Basophils [*10^9/L, M (Q1, Q3)]	0.02(0.01, 0.04)	0.02(0.01, 0.03)	0.222
IgG (mg/dL, )	667.22±283.69	1117.75±559.35	0.000
IgA [mg/dL, M (Q1, Q3)]	146(68.8, 212)	191(110, 342)	0.077
IgM [mg/dL, M (Q1, Q3)]	55.65(23.85, 117)	66.1(48.9, 92.2)	0.243
LDH (U/L, )	433.32±191.88	326.83±209.34	0.029
T lymphocytes in blood [cells/µL, M (Q1, Q3)]	417.77(275.65, 730.68)	545.38(356, 845.96)	0.230
B lymphocytes in blood [cells/µL, M (Q1, Q3)]	17.88(0.74, 90.8)	67.81(27.93, 139.74)	0.017
NK lymphocytes in blood [cells/µL, M (Q1, Q3)]	50.36(24.39, 122.07)	83.12(49.46, 126.34)	0.162
CD4+ in blood [cells/µL, M (Q1, Q3)]	166.2(100.49, 274.79)	295.05(147.87, 423.4)	0.014
CD8+ in blood [cells/µL, M (Q1, Q3)]	207.75(130.67, 494.91)	228.26(149.68, 408.87)	0.943
Ratio CD4+/CD8+ in blood ()	0.83±0.65	1.24±0.71	0.014
Ratio CD4+/CD8+ in BAL fluid ()	0.87±0.5	1.25±0.79	0.016
Lymphocytes in BAL fluid (%WBC, )	20.74±18.15	13.97±14.47	0.103

Note: ^a≥ 20mg/day mg of prednisone or equivalent for ≥1 month.

Table 2 Accuracy and Predictive Values of ROC Curve Analysis

	Threshold	Sensitivity	Specificity	PPV	NPV	+LR	-LR	Youden Index	AUC
IgG	713.5	78.6%	63.9%	79.3%	62.9%	2.18	0.33	0.425	76.4%
LDH	307.5	72.1%	69%	76.2%	62.5%	2.33	0.40	0.411	69.4%
B cells in blood	19.97	84.0%	54.1%	83.3%	55.3%	1.83	0.30	0.381	68.0%
CD4+ cells in blood	290.86	53.6%	83.3%	72.9%	68.2%	3.21	0.56	0.369	67.5%
CD4/CD8 in blood	0.56	85.7%	47.6%	83.3%	52.2%	1.64	0.30	0.333	70.3%
CD4/CD8 in BAL fluid	0.67	92.9%	42.9%	90.0%	52.0%	1.63	0.17	0.358	69.3%

Abbreviations: PPV, positive predictive value; NPV, negative predictive value; +LR, positive likelihood ratio; -LR, negative likelihood ratio; AUC, areas under the ROC curve.

Table 3 Stepwise, Forward Regression Analysis with All Possible Confounders

Dependent Variable	OR (95% CI)	Standard Error	p value
IgG < 713.5mg/dL	14.879(2.119–104.79)	0.994	0.007
CD4+/CD8+ in BAL fluid< 0.67	21.884(1.565–306.064)	1.346	0.022
LDH > 307.5U/L	17.292(2.334–128.104)	1.022	0.005

Table 4 Clinical Characteristics and Laboratory Indicators in the Survived and Deceased Groups

	Survived	Deceased	P-value
Patients(n)	31	13
Demographics
Age (year, )	55.58±14.36	56.38±20.72	0.900
Male [n (%)]	14(45.16%)	11(84.62%)	0.016
Immunosuppressive condition
Hematological malignancy [n (%)]	8(25.81%)	4(30.77%)	0.727
Solid tumor with chemotherapy [n (%)]	4(12.90%)	1(7.69%)	1.000
Autoimmune disease [n (%)]	19(61.29%)	8(61.54%)	0.988
Immunosuppressive therapies
Corticosteroids^a [n (%)]	25(80.65%)	10(76.92%)	0.780
Cyclophosphamide [n (%)]	3(9.68%)	2(15.38%)	0.623
Mycophenolate mofetil [n (%)]	3(9.68%)	1(7.69%)	1.000
Anticalcineurins [n (%)]	2(6.45%)	1(7.69%)	1.000
Anti-CD-20 agents [n (%)]	3(9.68%)	2(15.38%)	0.623
Anti-tumor chemotherapy [n (%)]	9(29.03%)	4(30.77%)	1.000
SOFA ()	2.84±1.73	6.23±3.65	0.006
WBC (*10^9/L, )	8.69±4.16	8.63±3.48	0.964
N (*10^9/L, )	7.08±3.4	7.84±3.31	0.501
L (*10^9/L, )	0.95±0.84	0.43±0.26	0.004
M (*10^9/L, )	0.47±0.72	0.31±0.23	0.439
E [*10^9/L, M (Q1, Q3)]	0.01(0, 0.04)	0(0, 0.02)	0.339
B [*10^9/L, M (Q1, Q3)]	0.02(0.01, 0.05)	0.02(0, 0.03)	0.144
IgG (mg/dL, )	651.6±258.71	702.73±345.02	0.625
IgA (mg/dL, )	152.96±95.17	174.22±134.69	0.591
IgM [mg/dL, M (Q1, Q3)]	52.2(30.6, 82.5)	78.5(17.4, 126)	0.685
LDH (U/L, )	380.22±167.57	570.5±188.49	0.002
T lymphocytes [cells/µL, M (Q1, Q3)]	446.47(360.42, 890.28)	267.12(152.91, 325.37)	0.001
B lymphocytes [cells/µL, M (Q1, Q3)]	16.81(0.74, 90.8)	42.88(0.34, 111.93)	0.832
NK lymphocytes (cells/µL, )	112.15±115.01	51.3±64.4	0.110
CD4+ (cells/µL, )	254.9±195.74	103.03±67.46	0.001
CD8+ [cells/µL, M (Q1, Q3)]	291.11(155.12, 552.37)	132.74(98.17, 208.96)	0.007
CD4/CD8 ()	0.88±0.75	0.71±0.35	0.306
CD4/CD8 in BAL fluid ()	0.86±0.57	0.89±0.26	0.864
L in BAL fluid (%WBC, )	25.7±19.47	9.68±6.97	0.000

Note: ^a≥ 20mg/day mg of prednisone or equivalent for ≥1 month.

Figure 2 ROC curves for the performance of different parameters for PCP.