Relationship between T lymphocyte subsets,interleukin-6 expression and prognosis of AIDS patients with moderate to severe pneumocystis jirovecii pneumonia

Liu Yanyan; Xue Tianjiao; Zhang Yuanyuan; Chen Qi; Tang Yanfen; Wang Yu

doi:10.3969/j.issn.1671-6450.2025.10.002

Abstract：Objective To analyze the relationship between T lymphocyte subsets,interleukin-6(IL-6)levels and prognosis in AIDS patients with moderate-to-severe pneumocystis jirovecii pneumonia(PCP).Method A retrospective analy-sis was conducted on the clinical data of 200 AIDS patients with moderate to severe PCP admitted to Respiratory Department of Beijing Ditan Hospital,Capital Medical University from April 2020 to June 2024.The patients were divided into a poor prognosis group(n=30)and a good prognosis group(n=170)based on their survival status within 30 days of treatment.Mult-ivariate Cox regression analysis was conducted to identify the influencing factors of prognosis in AIDS patients with moderate to severe PCP.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of T lymphocyte subsets and IL-6 levels for poor prognosis in AIDS patients with moderate to severe PCP.The dose-response relationship be-tween T lymphocyte subsets,IL-6 and poor prognosis in AIDS patients with moderate to severe PCP was explored.Results The proportion of severe PCP,human immunodeficiency virus(HIV)viral load,lactate dehydrogenase and IL-6 levels in the poor prognosis group were higher than those in the good prognosis group,and albumin,T lymphocyte CD3+and CD4+counts were lower than those in the good prognosis group(x2/t=5.267,11.112,5.561,6.714,5.159,4.933,5.741,all P＜0.05).High HIV viral load,elevated lactate dehydrogenase,and elevated L-6 were the influencing factors of poor prognosis in AIDS patients with moderate to severe PCP[HR(95％CI)=1.383(1.212-1.578),1.012(1.003-1.021),1.495(1.049-2.132)].Increased CD3+and CD4+count[HR(95％CI)=0.983(0.970-0.997),0.875(0.773-0.990)]of T lymphocytes were protective factors for good prognosis in AIDS patients with moderate to severe PCP.The area under the curve(AUC)of T lymphocyte CD3+,CD4+count,IL-6 alone and the combination of the three in predicting the poor prognosis of AIDS patients with moderate to severe PCP were 0.766,0.802,0.768 and 0.905,respectively.The AUC of the combination of the three in predicting the poor prognosis of patients was larger(Z=2.773,2.292,2.686,all P＜0.001).Restrictive cubic bar analysis showed that as T lymphocyte CD3+and CD4+counts decreased and IL-6 levels increased,the risk of poor prognosis in patients also rapidly increased.Conclusion T cell depletion and IL-6 elevation correlate with poor PCP outcomes in AIDS patients,with combined assessment providing optimal prognostic value.