Association of PCR cycle threshold values in respiratory specimens with mechanical ventilation and mortality in HIV-negative pneumocystis jirovecii pneumonia
- 1Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China; State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, 610041, China
- 2Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China; State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, 610041, China; Corresponding authors at: Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Abstract
Background: Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal disease that can be lethal . The study assessed the prognostic value of Pneumocystis cycle threshold (Ct) values for mechanical ventilation(MV) and mortality in human immunodeficiency virus(HIV)-negative patients. Methods: A retrospective observational cohort study was conducted at a tertiary teaching hospital from April 2024 to March 2025. PJP Ct values were measured using real-time polymerase chain reaction(PCR) in respiratory specimens. Logistic regression and Cox proportional hazards regression were performed to find variables linked with MV and mortality. Exploratory nomograms were developed for MV and mortality. Results: Among the 184 HIV-negative PJP patients, 68 (37%) required MV and 69 (38%) died. Multivariable logistic regression showed that higher Ct(adjusted odds ratio[aOR]=0.755; 95% confidence interval[CI] [0.632, 0.890]; BH-adjusted p [q]=0.001) and platelet-to-white cell ratio(PWR, aOR=0.946; 95% CI [0.912, 0.976]; q = 0.001) were associated with lower odds of requiring MV. Higher lactic dehydrogenase(LDH) levels(aOR=1.003; 95% CI [1.001, 1.006]; q = 0.006) and Systemic Immune-Inflammation Index (SII, aOR=1.001; 95% CI [1.000–1.001]; q = 0.001) were linked with greater odds of requiring MV. Cox analysis showed higher Ct(adjusted hazard ratio[aHR]=0.842, 95% CI [0.745–0.952], q = 0.009) and albumin-to-globulin ratio(AGR,aHR=0.283, 95% CI [0.122–0.659], q = 0.007) were associated with lower PJP-cause mortality, whereas adjunctive corticosteroids(aHR=2.701, 95% CI [1.417–5.149], q = 0.007), older age(aHR=1.029, 95% CI [1.005–1.053], q = 0.023), higher LDH(aHR=1.001, 95% CI [1.001–1.002], q = 0.006), and higher Systemic Inflammatory Response Index(SIRI) (aHR=1.054, 95% CI [1.020–1.088], q = 0.024) were associated with higher PJP-cause mortality. Conclusion: Lower Ct values were associated with higher mortality in patients with non-HIV PJP and may provide prognostic information. Higher age, adjunctive corticosteroid use, elevated SIRI, lower AGR and higher LDH were associated with higher PJP-cause mortality, whereas lower PWR, higher SII and higher LDH were associated with mechanical ventilation. These exploratory findings require further validation.
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BibTeX
@article{lv2026association,
title = {{Association of PCR cycle threshold values in respiratory specimens with mechanical ventilation and mortality in HIV-negative pneumocystis jirovecii pneumonia}},
author = {Wenting Lv and Jibo Sun and Qingqing Jia and Dajun Li and Sitong Liu and Shijie Zhang and Dongguang Wang and Lian Wang and Xing He and Xiang Tong and Hong Fan},
journal = {Journal of Infection and Public Health},
year = {2026},
month = oct,
doi = {10.1016/j.jiph.2026.103391},
url = {https://doi.org/10.1016/j.jiph.2026.103391},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association of PCR cycle threshold values in respiratory specimens with mechanical ventilation and mortality in HIV-negative pneumocystis jirovecii pneumonia
AU - Wenting Lv
AU - Jibo Sun
AU - Qingqing Jia
AU - Dajun Li
AU - Sitong Liu
AU - Shijie Zhang
AU - Dongguang Wang
AU - Lian Wang
AU - Xing He
AU - Xiang Tong
AU - Hong Fan
PY - 2026
DA - 2026/10/30
JO - Journal of Infection and Public Health
DO - 10.1016/j.jiph.2026.103391
UR - https://doi.org/10.1016/j.jiph.2026.103391
AB - Background: Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal disease that can be lethal . The study assessed the prognostic value of Pneumocystis cycle threshold (Ct) values for mechanical ventilation(MV) and mortality in human immunodeficiency virus(HIV)-negative patients. Methods: A retrospective observational cohort study was conducted at a tertiary teaching hospital from April 2024 to March 2025. PJP Ct values were measured using real-time polymerase chain reaction(PCR) in respiratory specimens. Logistic regression and Cox proportional hazards regression were performed to find variables linked with MV and mortality. Exploratory nomograms were developed for MV and mortality. Results: Among the 184 HIV-negative PJP patients, 68 (37%) required MV and 69 (38%) died. Multivariable logistic regression showed that higher Ct(adjusted odds ratio[aOR]=0.755; 95% confidence interval[CI] [0.632, 0.890]; BH-adjusted p [q]=0.001) and platelet-to-white cell ratio(PWR, aOR=0.946; 95% CI [0.912, 0.976]; q = 0.001) were associated with lower odds of requiring MV. Higher lactic dehydrogenase(LDH) levels(aOR=1.003; 95% CI [1.001, 1.006]; q = 0.006) and Systemic Immune-Inflammation Index (SII, aOR=1.001; 95% CI [1.000–1.001]; q = 0.001) were linked with greater odds of requiring MV. Cox analysis showed higher Ct(adjusted hazard ratio[aHR]=0.842, 95% CI [0.745–0.952], q = 0.009) and albumin-to-globulin ratio(AGR,aHR=0.283, 95% CI [0.122–0.659], q = 0.007) were associated with lower PJP-cause mortality, whereas adjunctive corticosteroids(aHR=2.701, 95% CI [1.417–5.149], q = 0.007), older age(aHR=1.029, 95% CI [1.005–1.053], q = 0.023), higher LDH(aHR=1.001, 95% CI [1.001–1.002], q = 0.006), and higher Systemic Inflammatory Response Index(SIRI) (aHR=1.054, 95% CI [1.020–1.088], q = 0.024) were associated with higher PJP-cause mortality. Conclusion: Lower Ct values were associated with higher mortality in patients with non-HIV PJP and may provide prognostic information. Higher age, adjunctive corticosteroid use, elevated SIRI, lower AGR and higher LDH were associated with higher PJP-cause mortality, whereas lower PWR, higher SII and higher LDH were associated with mechanical ventilation. These exploratory findings require further validation.
SN - 1876-0341
SN - 1876-035X
ER -