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<p>Although pneumocystis jirovecii pneumonia (PJP) in non-HIV patients is increasingly recognized, comprehensive data on immunosuppressive drivers remain limited. We conducted a population-based cohort study using a German health insurance’s claims data (2015–2023). PJP, comorbidities, immunocompromising conditions and therapies were identified by means of ICD-10-GM-, ATC- and OPS-coded records. 922,200 individuals were assessed for PJP occurrence, hospitalization and 30-day all-cause mortality. An Andersen-Gill model adjusted for key covariates. We identified 171 PJP episodes, with hospitalization in 88.3% and mortality in 24.5%. Frequent immunocompromising causes were hematologic cancers (42.6%), immunosuppressants (28.7%) and steroids (28.7%). Immunosuppression rather than typical CAP risk factors strongly predicted all outcomes (HR 49.9&#xa0;[31.5–78.9]). Robust associations with PJP occurred for HIV (HR 67.5&#xa0;[19.4–235]), systemic steroids (&gt; 20&#xa0;mg prednisone daily equivalent (HR 26.2&#xa0;[13.2–52.1])) and hematologic cancers (HR 8.5&#xa0;[4.5–16.3]). Mortality was driven by hematologic cancers (HR 13.9&#xa0;[4.8–40.2]) and high-dose steroids (HR 8.6&#xa0;[1.6–47.1]). Malignancy-related immunosuppression and steroids critically affect PJP risk and prognosis.</p>

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The role of cancer and immunosuppression in pneumocystis pneumonia: a large comprehensive population-based study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月6日

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  • Fabian Reichel,
  • Falko Tesch,
  • Saskia Berger,
  • Martin Seifert,
  • Dirk Koschel,
  • Jochen Schmitt,
  • Martin Kolditz

摘要

Although pneumocystis jirovecii pneumonia (PJP) in non-HIV patients is increasingly recognized, comprehensive data on immunosuppressive drivers remain limited. We conducted a population-based cohort study using a German health insurance’s claims data (2015–2023). PJP, comorbidities, immunocompromising conditions and therapies were identified by means of ICD-10-GM-, ATC- and OPS-coded records. 922,200 individuals were assessed for PJP occurrence, hospitalization and 30-day all-cause mortality. An Andersen-Gill model adjusted for key covariates. We identified 171 PJP episodes, with hospitalization in 88.3% and mortality in 24.5%. Frequent immunocompromising causes were hematologic cancers (42.6%), immunosuppressants (28.7%) and steroids (28.7%). Immunosuppression rather than typical CAP risk factors strongly predicted all outcomes (HR 49.9 [31.5–78.9]). Robust associations with PJP occurred for HIV (HR 67.5 [19.4–235]), systemic steroids (> 20 mg prednisone daily equivalent (HR 26.2 [13.2–52.1])) and hematologic cancers (HR 8.5 [4.5–16.3]). Mortality was driven by hematologic cancers (HR 13.9 [4.8–40.2]) and high-dose steroids (HR 8.6 [1.6–47.1]). Malignancy-related immunosuppression and steroids critically affect PJP risk and prognosis.