{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:19:45Z","timestamp":1792189185654,"version":"4.4.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82074212"],"award-info":[{"award-number":["82074212"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of this study was to evaluate the potential of metagenomic next-generation sequencing (mNGS) for the diagnosis of pneumocystis pneumonia (PCP) in patients with non-human immunodeficiency virus-infection and to discuss the clinical characteristics and identify prognostic factors associated with patients with non-HIV PCP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty-six patients with PCP who were admitted in respiratory intensive care unit (ICU) between May 2018 and May 2020 were retrospectively reviewed. The subjects were divided into survivor and non-survivor groups according to the patients' outcome. Conventional methods and mNGS for detecting <jats:italic>Pneumocystis jirovecii (P. jirovecii)<\/jats:italic> were analyzed. The patients' demographics, comorbidities, laboratory parameters, and treatments were compared and evaluated in both groups to identify risk factors for mortality by using univariate and multivariate logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Metagenomic next-generation sequencing (mNGS) showed a satisfying diagnostic performance of 100% positive of detecting <jats:italic>P. jirovecii<\/jats:italic> from bronchoalveolar lavage (BAL) specimens in forty-six patients with non-HIV PCP, compared to only 15.2% for Gomori Methenamine silver (GMS) staining and 84.8% for Serum 1,3-beta-D-glucan (BDG). Among them, the mean age was 46.4-year-old (range 18\u201379-year-old) and mortality rate was 43.5%. The dominant underlying conditions were connective tissue diseases (34.8%), autoimmune kidney diseases (30.4%), followed by hematologic malignancies (10.9%), and solid organ transplantation (6.5%). A total of 38 cases (82.6%) received glucocorticoid and 19 cases (41.3%) used immunosuppressant within 3 months before diagnosed PCP. Multiple infections were very common, over two thirds' cases had mixed infections. Compared with survivors, non-survivors had a higher acute physiology and chronic health evaluation II (APACHE II) score (14.4 \u00b1 4.8 vs. 10 \u00b1 3.4), Procalcitonin (PCT) [ng\/ml: 0.737 (0.122\u20131.6) vs. 0.23 (0.095\u20130.35)], lactic dehydrogenase (LDH) [U\/L: 1372 (825.5\u20132150) vs. 739 (490.5\u2013956)], and neutrophil-lymphocyte ratio (NLR) [21.6 (15.67\u201338.2) vs. 11.75 (5.1\u201315.52)], but had a lower PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> ratio (mmHg:108.8 \u00b1 42.4 vs. 150.5 \u00b1 47.5), lymphocytes [\u00d710<jats:sup>9<\/jats:sup>\/L: 0.33 (0.135\u20130.615) vs. 0.69 (0.325\u20131.07)] and CD4+ T cells [cell\/\u03bcl: 112 (53.5\u2013264) vs. 255 (145\u2013303.5)], all <jats:italic>P<\/jats:italic> &amp;lt; 0.05. Furthermore, we found non-survivors' PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> ratio of day 3 and day 7 had not improved when compared with that of day one, and platelet level and NLR became worse. Multivariate analysis showed that other pathogens' co-infection (OR = 9.011, 95% CI was 1.052\u201377.161, <jats:italic>P<\/jats:italic> = 0.045) and NLR (OR = 1.283, 95% CI was 1.046\u20131.547, <jats:italic>P<\/jats:italic> = 0.017) were the independent risk factors of poor prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>mNGS is a very sensitive diagnostic tool for identifying <jats:italic>P. jirovecii<\/jats:italic> in patients who are non-HIV immunocompromised. PCP in patients who are non-HIV infected is associated with a high rate of multiple infections and severe condition. Mixed infection and elevation of NLR were the independent risk factors of poor prognosis.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.812698","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T10:22:10Z","timestamp":1646302930000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["Characteristics and Prognostic Factors of Non-HIV Immunocompromised Patients With Pneumocystis Pneumonia Diagnosed by Metagenomics Next-Generation Sequencing"],"prefix":"10.3389","volume":"9","author":[{"given":"Jiali","family":"Duan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuhong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengfei","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingshuai","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Xing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e334","DOI":"10.1016\/S1473-3099(17)30303-1","article-title":"Fungal infections in HIV\/AIDS","volume":"17","author":"Limper","year":"2017","journal-title":"Lancet Infect Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e13518","DOI":"10.5812\/jjm.13518","article-title":"The prevalence of Pneumocystis jiroveci in bronchoalveolar lavage specimens of lung transplant recipients examined by the nested PCR","volume":"7","author":"Izadi","year":"2014","journal-title":"Jundishapur J Microbiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2487","DOI":"10.1056\/NEJMra032588","article-title":"Pneumocystis pneumonia","volume":"350","author":"Thomas","year":"2004","journal-title":"N Engl J Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1055\/s-0039-3399559","volume":"41","author":"Fishman","year":"2020","journal-title":"Pneumocystis jiroveci. 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