{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:03:38Z","timestamp":1791655418574,"version":"4.3.4"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2018,12,1]],"date-time":"2018-12-01T00:00:00Z","timestamp":1543622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>The incidence of Pneumocystis jirovecii pneumonia (PjP) is rising. Longer time to treatment is associated with higher mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To develop a multivariable risk prediction model for PjP diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a prospective multicenter cohort of ICU patients with hematological malignancies and acute respiratory failure, factors associated with documented PjP were identified. The risk prediction model was tested in an independent prospective multicenter cohort. We assessed discrimination (by areas under the receiver operating characteristic curves [AUCs]) and goodness of fit (by Hosmer-Lemeshow statistics). Model performance was assessed using 30 sets of imputed data sets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Among the 1,330 patients, 134 of 1,092 (12.3%; 95% confidence interval [CI], 10.4\u201314.4%) had proven PjP in the derivation cohort, as did 15 of 238 (6.3%, 95% CI, 3.6\u201310.2%) in the validation cohort. The model included age, lymphoproliferative disease, anti-Pneumocystis prophylaxis, the number of days between respiratory symptom onset and ICU admission, shock, chest radiograph pattern, and pleural effusion. The median (interquartile range) score was 3.5 (1.5\u20135.0) (range, \u22123.5 to 8.5) in the derivation cohort and 1.0 (0\u20132.0) (range, \u22123.5 to 6.0) in the validation cohort. The best threshold was defined on the validation sample as 3, allowing us to reach 86.7% sensitivity and 67.7% specificity for PjP, with a negative predictive value of 97.9% in the case of 10% prevalence. The score had good calibration (goodness of fit, \u22120.75) and discrimination in the derivation cohort (mean AUC, 0.80; 95% CI, 0.76\u20130.84) and validation cohort (mean AUC, 0.83; 95% CI, 0.72\u20130.93).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The PjP score for hematology patients with acute respiratory failure can be computed at admission, based on readily available variables. Potential clinical benefits of using this score deserve assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201712-2452oc","type":"journal-article","created":{"date-parts":[[2018,7,11]],"date-time":"2018-07-11T12:12:58Z","timestamp":1531311178000},"page":"1519-1526","source":"Crossref","is-referenced-by-count":54,"title":["A Multivariable Prediction Model for\n                    <i>Pneumocystis jirovecii<\/i>\n                    Pneumonia in Hematology Patients with Acute Respiratory Failure"],"prefix":"10.1093","volume":"198","author":[{"given":"Elie","family":"Azoulay","sequence":"first","affiliation":[{"name":"Medical ICU and"},{"name":"Biostatistics Department, St.-Louis University Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Roux","sequence":"additional","affiliation":[{"name":"Respiratory and Lung Transplant Unit, Foch Hospital, Suresnes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Vincent","sequence":"additional","affiliation":[{"name":"Medical-Surgical ICU, Avicenne University Hospital, Bobigny, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achille","family":"Kouatchet","sequence":"additional","affiliation":[{"name":"Medical ICU, Angers University Hospital, Angers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Argaud","sequence":"additional","affiliation":[{"name":"Medical ICU, Lyon University Hospital, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Rabbat","sequence":"additional","affiliation":[{"name":"Respiratory Unit and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Mayaux","sequence":"additional","affiliation":[{"name":"Medical ICU, Piti\u00e9 Salp\u00eatri\u00e8re Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Perez","sequence":"additional","affiliation":[{"name":"Medical ICU, Nancy University Hospital, Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"P\u00e8ne","sequence":"additional","affiliation":[{"name":"Medical ICU, Cochin University Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martine","family":"Nyunga","sequence":"additional","affiliation":[{"name":"Medical-Surgical ICU, Roubaix Hospital, Roubaix, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrice","family":"Bruneel","sequence":"additional","affiliation":[{"name":"Medical-Surgical ICU, Versailles Hospital, Le Chesnay, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kada","family":"Klouche","sequence":"additional","affiliation":[{"name":"Medical ICU, Montpellier University Hospital, Montpellier, France; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Djamel","family":"Mokart","sequence":"additional","affiliation":[{"name":"Medical-Surgical ICU, Paoli Calmettes Institute, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Darmon","sequence":"additional","affiliation":[{"name":"Medical ICU and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Chevret","sequence":"additional","affiliation":[{"name":"Biostatistics Department, St.-Louis University Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lemiale","sequence":"additional","affiliation":[{"name":"Medical ICU and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,12,15]]},"reference":[{"key":"2026032023292300600_bib1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jinf.2016.10.005","article-title":"Estimating the burden of invasive and serious fungal disease in the United Kingdom","volume":"74","author":"Pegorie","year":"2017","journal-title":"J Infect"},{"key":"2026032023292300600_bib2","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3201\/eid2007.140087","article-title":"Population-based analysis of invasive fungal infections, France, 2001\u20132010","volume":"20","author":"Bitar","year":"2014","journal-title":"Emerg Infect Dis"},{"key":"2026032023292300600_bib3","doi-asserted-by":"crossref","first-page":"2487","DOI":"10.1056\/NEJMra032588","article-title":"Pneumocystis pneumonia","volume":"350","author":"Thomas","year":"2004","journal-title":"N Engl J Med"},{"key":"2026032023292300600_bib4","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1177\/1753465810380102","article-title":"Update on the diagnosis and treatment of Pneumocystis pneumonia","volume":"5","author":"Carmona","year":"2011","journal-title":"Ther Adv Respir Dis"},{"key":"2026032023292300600_bib5","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1378\/chest.128.2.573","article-title":"Acute respiratory failure due to pneumocystis pneumonia in patients without human immunodeficiency virus infection: outcome and associated features","volume":"128","author":"Festic","year":"2005","journal-title":"Chest"},{"key":"2026032023292300600_bib6","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1111\/ijd.13231","article-title":"Pneumocystis jiroveci pneumonia in patients treated with systemic immunosuppressive agents for dermatologic conditions: a systematic review with recommendations for prophylaxis","volume":"55","author":"Gonzalez Santiago","year":"2016","journal-title":"Int J Dermatol"},{"key":"2026032023292300600_bib7","doi-asserted-by":"crossref","first-page":"663","DOI":"10.7326\/0003-4819-100-5-663","article-title":"Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies","volume":"100","author":"Kovacs","year":"1984","journal-title":"Ann Intern Med"},{"key":"2026032023292300600_bib8","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1001\/jama.286.19.2450","article-title":"New insights into transmission, diagnosis, and drug treatment of Pneumocystis carinii pneumonia","volume":"286","author":"Kovacs","year":"2001","journal-title":"JAMA"},{"key":"2026032023292300600_bib9","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1164\/ajrccm.160.2.9901019","article-title":"AIDS-related Pneumocystis carinii pneumonia in the era of adjunctive steroids: implication of BAL neutrophilia","volume":"160","author":"Azoulay","year":"1999","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023292300600_bib10","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1038\/nrmicro1621","article-title":"Current insights into the biology and pathogenesis of Pneumocystis pneumonia","volume":"5","author":"Thomas","year":"2007","journal-title":"Nat Rev Microbiol"},{"key":"2026032023292300600_bib11","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1378\/chest.07-0223","article-title":"Clinical picture of Pneumocystis jiroveci pneumonia in cancer patients","volume":"132","author":"Boll\u00e9e","year":"2007","journal-title":"Chest"},{"key":"2026032023292300600_bib12","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1111\/j.1469-0691.2010.03400.x","article-title":"Real-time PCR assay\u2013based strategy for differentiation between active Pneumocystis jirovecii pneumonia and colonization in immunocompromised patients","volume":"17","author":"Alanio","year":"2011","journal-title":"Clin Microbiol Infect"},{"key":"2026032023292300600_bib13","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.3201\/eid2009.131668","article-title":"Pneumocystis jirovecii pneumonia in patients with or without AIDS, France","volume":"20","author":"Roux","year":"2014","journal-title":"Emerg Infect Dis"},{"key":"2026032023292300600_bib14","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1164\/rccm.201001-0018OC","article-title":"Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial","volume":"182","author":"Azoulay","year":"2010","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023292300600_bib15","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1128\/JCM.03174-15","article-title":"Detection of Pneumocystis jirovecii by quantitative PCR to differentiate colonization and pneumonia in immunocompromised HIV-positive and HIV-negative patients","volume":"54","author":"Fauchier","year":"2016","journal-title":"J Clin Microbiol"},{"key":"2026032023292300600_bib16","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1001\/jama.2015.12402","article-title":"Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure: a randomized clinical trial","volume":"314","author":"Lemiale","year":"2015","journal-title":"JAMA"},{"key":"2026032023292300600_bib17","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1097\/01.md.0000145370.63676.fb","article-title":"The prognosis of acute respiratory failure in critically ill cancer patients","volume":"83","author":"Azoulay","year":"2004","journal-title":"Medicine (Baltimore)"},{"key":"2026032023292300600_bib18","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s13613-016-0202-0","article-title":"Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology: a Groupe de Recherche en R\u00e9animation Respiratoire en Onco-H\u00e9matologique (Grrr-OH) study","volume":"6","author":"Contejean","year":"2016","journal-title":"Ann Intensive Care"},{"key":"2026032023292300600_bib19","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1007\/s00134-017-4947-1","article-title":"Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study","volume":"43","author":"Azoulay","year":"2017","journal-title":"Intensive Care Med"},{"key":"2026032023292300600_bib20","doi-asserted-by":"crossref","first-page":"2810","DOI":"10.1200\/JCO.2012.47.2365","article-title":"Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium\u2014a Groupe de Recherche Respiratoire en R\u00e9animation Onco-H\u00e9matologique study","volume":"31","author":"Azoulay","year":"2013","journal-title":"J Clin Oncol"},{"key":"2026032023292300600_bib21","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1007\/s00134-017-4884-z","article-title":"The intensive care medicine research agenda on critically ill oncology and hematology patients","volume":"43","author":"Azoulay","year":"2017","journal-title":"Intensive Care Med"},{"key":"2026032023292300600_bib22","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1007\/s00134-017-4821-1","article-title":"The intensive care medicine research agenda on septic shock","volume":"43","author":"Perner","year":"2017","journal-title":"Intensive Care Med"},{"key":"2026032023292300600_bib23","doi-asserted-by":"crossref","first-page":"1242.e11","DOI":"10.1016\/j.amjmed.2014.07.010","article-title":"Incidence of Pneumocystis jiroveci pneumonia among groups at risk in HIV-negative patients","volume":"127","author":"Fillatre","year":"2014","journal-title":"Am J Med"},{"key":"2026032023292300600_bib24","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1111\/imj.12599","article-title":"Consensus guidelines for diagnosis, prophylaxis and management of Pneumocystis jirovecii pneumonia in patients with haematological and solid malignancies, 2014","volume":"44","author":"Cooley","year":"2014","journal-title":"Intern Med J"},{"issue":"10","key":"2026032023292300600_bib25","first-page":"CD005590","article-title":"Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients","author":"Stern","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"2026032023292300600_bib26","doi-asserted-by":"crossref","first-page":"586","DOI":"10.4187\/respcare.03593","article-title":"An international survey on noninvasive ventilation use for acute respiratory failure in general non-monitored wards","volume":"60","author":"Cabrini","year":"2015","journal-title":"Respir Care"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/198\/12\/1519\/67120916\/ajrccm_198_12_1519.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/198\/12\/1519\/67120916\/ajrccm_198_12_1519.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T03:31:14Z","timestamp":1774063874000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/198\/12\/1519\/8498459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12]]},"references-count":26,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2018,12,15]]},"published-print":{"date-parts":[[2018,12,15]]}},"URL":"https:\/\/doi.org\/10.1164\/rccm.201712-2452oc","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,12]]},"published":{"date-parts":[[2018,12]]}}}