A retrospective, multicenter study on the pneumocystis jirovecii pneumonia in critically ill children with non-human immunodeficiency virus using metagenomics next-generation sequencing

A retrospective, multicenter study on the pneumocystis jirovecii pneumonia in critically ill children with non-human immunodeficiency virus using metagenomics next-generation sequencing | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A retrospective, multicenter study on the pneumocystis jirovecii pneumonia in critically ill children with non-human immunodeficiency virus using metagenomics next-generation sequencing Liming He, Yibing Cheng, Li Huang, Zhenyu Zhang, Qunqun Zhang, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7061414/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Feb, 2026 Read the published version in BMC Pulmonary Medicine → Version 1 posted 14 You are reading this latest preprint version Abstract Background Pneumocystis jirovecii (PJ) is a life-threatening opportunistic pathogen and an important cause of severe pneumonia in immunocompromised children. Accurate and timely diagnosis is the most important factor for improving pneumocystis jirovecii pneumonia (PCP) related mortality in individuals with non-human immunodeficiency virus (non-HIV) infection. Methods We retrospectively collected clinical data from critically ill children with PJ positive in the metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF). Results A total of 59 non-HIV children were included in this study. We classified the children into the PCP group (n = 51) and pneumocystis jirovecii colonization (PCC) group (n = 8). When compared with the PCC group, the PCP group had lower lymphocyte numbers, higher C-reactive protein (CRP), a higher proportion of primary immunodeficiency disease, a higher imaging change of ground-glass opacity on CT scans and higher median mNGS reads number of PJ (all p < 0.05). The optimal threshold value for discriminating pneumocystis jirovecii infection from colonization appeared to be 556 reads (sensitivity, 77.6%; specificity, 100.0%). Conclusions The BALF mNGS may assist with differentiating between colonization and infection of pneumocystis jirovecii, which needs further investigation. Metagenomic next-generation sequencing Pneumocystis jirovecii pneumonia Non-human immunodeficiency virus Children Figures Figure 1 Figure 2 Background Pneumocystis jirovecii (PJ) is an opportunistic pathogen that can cause pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients 1 . PCP used to occur among the human immunodeficiency virus (HIV)-infected persons. In recent years, after the introduction of the highly effective antiretroviral treatment for HIV, and the widespread use of immunosuppressants and/or chemotherapeutics in patients with solid tumors, hematologic malignant disease, rheumatic diseases, and other diseases, the incidence of PCP in HIV-infected patients has significantly decreased, while the incidence among non-HIV-infected immunocompromised patients has increased year by year 2 , 3 . The non-HIV-infected patients with PCP usually develop an acute course of disease with a higher mortality (28–53%) than the HIV-infected patients (17–30%) 4–6 . The main symptoms include fever, dry cough, chest pain, and dyspnea. The typical radiological features are bilateral, diffuse ground-glass opacity, accompanied by slab stone signs, patchy shadows, interstitial changes, and pneumonectasis 6 . The prognosis of PCP in non-HIV patients depends on early diagnosis, early treatment, early appropriate prophylaxis for high-risk populations, and early identification of severe cases 2 . PJ mainly parasitizes the pulmonary alveoli in the form of cysts and trophozoites. The gold standard for the diagnosis of PCP has been the microscopic visualization of cysts and trophozoites in respiratory specimens such as BALF or sputum. Due to its low sensitivity, the positive rate was low 7 . With the rapid development of metagenomic next-generation sequencing (mNGS) technology to detect target organisms in critically ill patients, articles on the application of mNGS technology to detect PCP have emerged 8 , 9 . However, to our knowledge, articles on the performance of mNGS for diagnosis of PCP by BALF in non-HIV critically pediatric patients were few and they all have been small sample, single-center studies 10 , 11 . Based on it, we designed a multicenter, retrospective study that enrolled non-HIV children with PCP infection admitted in pediatric intensive care unit (PICU) of four children’s hospitals, between January 2019 and May 2023. We aimed to analyze the clinical characteristics of non-HIV children with PCP and to evaluate the value of mNGS of BALF in diagnosing PCP in non-HIV critically pediatric patients. Materials and Methods Study population In this multicenter, retrospective study, we enrolled patients who were admitted to the PICU of Children’s Hospital of Fudan University, Guangzhou Women and Children’s Medical Center, Henan Children’s Hospital and Hunan Children’s Hospital from January 2019 to May 2023. These patients underwent mNGS of BALF for severe pneumonia and were treated with trimethoprim/sulfamethoxazole (TMP/SMZ) when the PCP was confirmed. Inclusion and exclusion criteria According to the revised EORTC/MSGERC consensus definitions of PCP in individuals without HIV and the results of mNGS of BALF, the patients were divided into the probable PCP (PCP) group and pneumocystis jirovecii colonization (PCC)group 6 . Probable PCP was defined by the appropriate host factors, clinical and radiologic criteria, blood 1,3-β-D-glucan (BDG) positive twice and the detection of PJ by mNGS in the BALF. The PCC group was defined by the detection of PJ by mNGS in the BALF without appropriate host factors, or clinical and radiologic appearance. The details were as follows: (1) immunosuppressed hosts without HIV infection; (2) cough, fever, and shortness of breath; (3) radiological appearance of diffuse ground-glass opacity with interstitial infiltrates, consolidated or reticulate shadows in both lungs; (5) blood BDG ≥ 100 pg/ml twice; (4) detection of PJ by mNGS in the BALF. Grouping patients based on the above criteria was made after discussion with the medical team. The exclusion criteria were (1) HIV infection; (2) mNGS sample was not from BALF; (3) incomplete medical record. BALF collection and preservation The BALF was collected by experienced respiratory therapists according to the guidelines 12 , 13 . The quality requirements for the BALF samples were as follows: (1) a ≥ 40% recovery rate; (2) without mixture with blood (< 10% red blood cells); (3) collection of lavage fluid from diseased lung segments based on recent chest CT results or from the right middle lobe for the diffuse lung disease; (4)lavage volume: 1ml/kg for each time, ≤ 20 mL for each time, and ≤ 5–10 mL/kg for total fluid; The samples were collected in a sterile container and sent for analysis within 2 hours. For specimens that could not be sent in time, they could be stored in a 4-degree refrigerator and analyzed within 24 hours. Metagenomic Next-Generation Sequencing Analysis We performed mNGS regarding our previously published studies 14 , 15 . Briefly, It included 1) DNA extraction and pretreatment: A 0.6-3 ml BALF was inactivated and mixed with the glass grinding beads to do the wall breaking process. Then the DNA was extracted using the TIANamp Micro DNA Kit (No. DP316, Tiangen Biochemical Technology, Beijing, China) according to the kit instructions. 2) Library construction: First, the end repair, ligation and PCR amplification of the DNA fragments were performed using the MGIEasy Cell-free DNA Library Prep Kit (MGI tech, Shenzhen, China) according to the manufacturer's kit; Then, the libraries were quality controlled using the 2100 Bioanalyzer (Agilent, USA) with a qualified library fragment size of 200–300 bp, and a Qubit dsDNA HS Assay Kit (Thermo Fisher Scientific, USA) for DNA library concentration of > 2 ng/µL; Finally, the different samples were mixed in equal amounts of nucleic acid for subsequent operations. 3) High throughput sequencing: High-throughput sequencing is done by BGISEQ-50 (MGI tech, Shenzhen, China) referring to the manufacturer's instructions. 4) Sequencing data pre-processing: The sequencing data obtained were first subjected to data quality control to remove low quality and reads with sequence lengths less than 35bp reads to obtain high quality reads; The high quality reads were then compared to the human reference genome (version hg19) by BWA software (version 0.7.15-r1140) to remove contamination from human-derived sequences; The remaining data were based on prinseq software (version 0.20.4) after removing repetitive, low-complexity sequences, and then aligned to the PMDB pathogen database (BGI's internal database of 4945 viruses, 6039 bacteria (excluding Mycobacterium), 174 Mycobacterium, 137 Mycoplasma, Chlamydia 1064 fungi and 234 parasites associated with human diseases); The microbial sequence data obtained after the alignment were annotated according to viruses, bacteria, fungi and parasites. Clinical data collection We recorded patient data including demographics, underlying diseases, clinical symptoms, and signs, laboratory test results and radiological results within one week of positive PJ mNGS, pediatric logistic organ dysfunction-2 (PELOD-2) score when inpatient, previous use of glucocorticoids or immunosuppressants, time from onset to use of TMP/SMZ, pathogen test results, and discharge outcomes. Statistical analysis Analyses were carried out using the SPSS version 23.0 platform (SPSS, Inc., Chicago, IL, USA). Normally distributed variables were expressed as mean ± standard deviation and were compared using a student’s t -test. Nonparametric continuous variables were presented as median (interquartile range) values and compared using a Mann–Whitney U -test. Categorical variables were expressed as percentages and compared using an χ 2 test or Fisher exact probability. A multivariate logistic regression analysis was done for mortality factors. The receiver operating characteristic curve (ROC) analysis was employed to assess the value of BALF mNGS in differentiating between PJ infection and colonization. The Yuden index was used to determine the optimal threshold and its sensitivity and specificity. A value of P < 0.05 was considered statistically significant. Results Population Characteristics As Figure 1 showed, from January 2019 to May 2023, we identified 86 mNGS PJ positive children in the above four PICUs of Children’s Hospitals. One of them was infected with HIV and one’s sample was from blood, then excluded from the study. Twenty- five patients were excluded for the missing original reports. We finally enrolled 59 pediatric patients. According to the 2021 EORTC/MSGERC definition of PCP and the results of mNGS, the cases were classified into the PCP group (n=51) and the PCC group (n=8). The number of patients included in each hospital was: 42 in the Children’s Hospital of Fudan University (40 occurred PCP and 2 occurred PCC), 5 in the Guangzhou Women and Children’s Medical Center (4 occurred PCP and 1 occurred PCC), 5 in the Human Children’s Hospital (4 occurred PCP and 1 occurred PCC) and 7 in the Henan Children’s Hospital (3 occurred PCP and 4 occurred PCC). 42 out of 51 patients (71.2%) were males. The age ranged from two months to fourteen years (the median age was ten months). The underlying disease included the primary immunodeficiency disease (n=24), solid tumor (n=14), hematologic malignant diseases (n=4), hematopoietic stem cell transplantation (HSCT) (n=2), solid organ transplantation (n=3), rheumatic disease (n=2), nephrotic syndrome (n=2), inherited metabolic disease (n=2) and so on. Fifty two cases (88.1%) run fever. The number of patients requiring invasive/ non-invasive mechanical ventilation was 51 cases (86.4%). Co-infections were detected in 46/59 (78.0%) children. The top five pathogens were Cytomegalovirus (n=21, 35.6%), Epstein-Barr virus (n=6, 10.2%), Acinetobacter baumannii (n=5, 8.5%), Mycobacterium tuberculosis (n=4, 6.8%), Streptococcus pneumoniae (n=4, 6.8%). The results were shown in Table 1. Comparison between the PCP group and the PCC group According to the definition of PCP in this study, we classified the enrolled patients into the PCP group (n= 51) and the PCC group (n= 8). When compared with the PCC group, peripheral blood lymphocytes were significantly lower in PCP patients (p=0.004). C-reactive protein (CRP) was significantly higher in PCP patients (p=0.004). The median of BDG was significantly higher in PCP patients than that in the PCC patients (p＜0.001). Lactic dehydrogenase (LDH) in the PCP and PCC group were 720(539, 978) μ/l and 372(279, 752) μ/l respectively, which was higher in the PCP group but with no statistical significance. Meanwhile the count of CD regulatory T cells (CD3, CD4, and CD8) was lower in the PCP group than those in the PCC group, but with no statistical significance (p=0.078, 0.061, and 0.078, respectively). The median mNGS read number of PJ was significantly higher in the PCP group than in the PCC group (5955 vs. 8, p＜0.001). The area under the curve was 0.937 (95%CI: 0.865–1.000) for mNGS read number of PJ in BALF (Figure 2). The optimal threshold value for discriminating PJ infection from colonization appeared to be 556 reads (sensitivity, 77.6%; specificity, 100.0%) When the Youden index was at its maximum (0.776). For underlying diseases, the proportion of patients with primary immunodeficiency in the PCP group was significantly higher than that in the PCC group (p=0.033). Diffuse ground-glass opacity was significantly more common in the PCP group (p=0.020). The combination therapy of caspofungin and TMP/SMZ was higher in the PCP group (p=0.025). There was no statistically significant difference between the two groups in terms of age, weight, and gender (Table 2). Comparison of patients with different outcomes at discharge in the PCP group We classified the PCP patients into non-survivors (n=18) and survivors (n=33) at discharge and analyzed the prognosis factor of PCP. Compared with the survivors, the non-survivors had younger ages, lower weight, and shorter hospital stays (all p＜0.05). The CD3 counts in the non-survivors and survivors were 126(51, 590) cells/μl and 542(234, 1721) cells/μl respectively, CD4 counts were 38(4, 65) cells/μl and 268(64, 1015) cells/μl, CD8 counts were 60(6, 120) cells/μl and 262(121, 635)cells/μl, CD4 ratio was 14.55(2.10, 32.57) and 27.91(15.10, 45.53), which were all significantly lower in the non-survivors than these in the survivors (all p＜0.05). The proportion of patients with primary immunodeficiency in the non-survivors was significantly higher than that in the survivors (p=0.008). The PELOD-2 score at admission was also significantly higher in the non-survivors than in the survivors (p=0.016) (Table 3). A multivariable logistic analysis showed age, weight, CD counts (CD3, CD4, CD8, and CD4 ratio), the PELOD-2 score at admission, and the proportion of primary immunodeficiency were all not related to the prognosis. Comparison of primary immunodeficiency patients and secondary immunodeficiency patients in PCP group We divided the PCP group into the primary immunodeficiency (n=24) and secondary immunodeficiency (n=27) groups according to the basic disease and analyzed the difference between them. When compared with the secondary immunodeficiency group, the primary immunodeficiency group had a younger age, lower weight, higher white cell counts and lymphocyte counts, and lower IL-6 expression (all p＜0.05). The CD4 counts in the primary and secondary immunodeficiency groups were 175(12, 728) cells/μl and 77(35, 524) cells/μl respectively, the median were all below 200 cells/μl. The CD4/CD8 ratio was higher in the primary immunodeficiency group than in the secondary immunodeficiency group (p=0.012). The mortality at discharge was significantly higher in the primary immunodeficiency group than in the secondary immunodeficiency group (54.2% vs. 18.5%, p=0.008). There was no statistical significance in the hospital stay, PICU stay, Invasive/non-invasive mechanical ventilation rate, and the number of PJ reads in the BALF mNGS and BDG between the two groups (Table 4). Discussion Pneumocystis jirovecii is a life-threatening opportunistic pathogen and an important cause of severe pneumonia in immunocompromised children 16 . Accurate and timely diagnosis is the most important factor for improving PCP-related mortality in individuals with non-HIV infection. PJ mainly parasitizes the pulmonary alveoli in the form of cysts and trophozoites. It cannot be cultured in vitro so far, and the detection rate of existing methods is low 2 , 7 . As a rapid, unbiased pathogen detection technology, mNGS has the advantages of high sensitivity, comprehensive, and timely identifying pathogen infection in critically ill children 17 , 18 . In this multicenter retrospective observational study, we finally enrolled 59 BALF PJ positive children using mNGS technology and timely adjusted anti-infective therapeutic schemes for 26 patients (44.1%). The mortality was 33.9% at discharge, while the reported mortality of non-HIV PCP children ranged from 11.8–41.7% 10,11,19 . Solid tumors and hematologic malignancies are the most common basic diseases in most of the studies for PCP-infected adults with non-HIV infection 20 , 21 . However, in our study, about 47.1% (24/51) of PCP children were primary immunodeficiency disease. Differences in the spectrum of diseases in adults and children might contribute to this result. The children with primary immunodeficiency disease had younger age, lower weight, and significantly higher mortality than those with secondary immunodeficiency disease. It indicated that the primary immunodeficiency children with PCP may have a poor prognosis. Appropriate prophylaxis should be considered in primary immunodeficiency disease children. We classified the enrolled patients into the PCP group (n = 51) and the PCC group (n = 8) according to the definition of PCP in our study. When compared with the PCC group, the PCP group had lower lymphocyte numbers, higher CRP, a higher proportion of primary immunodeficiency disease, a higher imaging change of ground-glass opacity on CT scans, higher BDG results and higher median mNGS reads number of PJ (all p < 0.05). While in Li Liu and his colleagues‘s study, they found that the PCP group had higher levels of LDH and CRP than those in the PCC group 22 . When compared with the survivors, non-survivors of PCP infections had younger age, lower CD regulatory T cell counts (CD3, CD4, and CD8), higher proportion of primary immunodeficiency disease, and higher PELOD-2 score. In comparison, a multivariable logistic analysis detected no risk factor for a poor prognosis. Chen Ling and her colleagues reported that compared with the survivors, the non-survivors with PCP in non-HIV children also had younger ages and a higher proportion of primary immunodeficiency disease. At the same time, the LDH level, co-infection, and need for mechanical ventilation were the risk factors for a poor prognosis of PCP 19 . Differences in the spectrum of diseases might contribute to part of the difference. For patients with impaired immune function, the probability of mixed infections of multiple pathogens in the lungs is significantly increased. In this study, about 78.0% of enrolled patients had mixed infections. Among the mixed infections, CMV was the most common pathogen which was consistent with previous related studies 10 , 11 . The mNGS technology has the advantage of unbiased sequencing by extracting total DNA or RNA, fragmentation, library preparation, and deep sequencing from original samples 23 . As a rapid, unbiased pathogen detection technology, mNGS has the advantages of comprehensive, rapid, and high sensitivity in the diagnosis of PJ infection. However, blind treatment based on mNGS lonely is inappropriate, since mNGS technology cannot distinguish pathogens between colonization and infection. At the same time, due to its high sensitivity, false positive results may occur, while incomplete wall breaking may lead to false negative results 23 . In our study, the number of mNGS reads for PJ was significantly higher in the PCP group than in the PCC group. The optimal threshold values for discriminating PJ infection from colonization appeared to be 556 reads (sensitivity, 77.6%; specificity, 100.0%). In Li Liu and his colleagues’ study on PCP-infected adults, they showed that the optimal threshold was 14 reads with a sensitivity of 83.3% and specificity of 95.7% 22 . Different subjects and underlying diseases might arrive at different results. BALF mNGS may be a useful technology that can assist with distinguishing between infection and colonization of PJ, but more research is needed to determine the cut-off values. Our study has some limitations. Firstly, this was a retrospective study relying on existing medical records that were not enough to meet the requirements of the investigation. Secondly, we enrolled a relatively small sample size due to the incomplete medical records. A larger study sample is needed to confirm our results. Finally, whether prophylactic use of TMP/SMZ before BALF collection was not distinguished. It might influence the reads of BALF mNGS. Conclusion The mNGS technology is an efficient and useful diagnostic technology for PCP in critically pediatric patients. BALF samples for mNGS are recommended for the presumptive diagnosis of PCP. BALF mNGS may help distinguish infection from colonization of PJ but more research is needed to verify. Abbreviations PJ Pneumocystis jirovecii PCP Pneumocystis jirovecii pneumonia HIV Human immunodeficiency virus mNGS Metagenomic next-generation sequencing BALF Bronchoalveolar lavage fluid PCC Pneumocystis jirovecii colonization CRP C-reactive protein PICU Pediatric intensive care unit TMP/SMZ Trimethoprim/sulfamethoxazole BDG 1,3-β-D-glucan PELOD-2 Pediatric logistic organ dysfunction-2 ROC Receiver operating characteristic curve HSCT Hematopoietic stem cell transplantation LDH Lactic dehydrogenase Declarations Ethics approval and consent to participate The ethics committee approved this study at the Children’s Hospital of Fudan University with an IRB of 2019 − 312. Informed consent to participate was taken from parents/legal guardians of minor participants. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are available in the China National GeneBank Sequence Archive (CNSA), (https://db.cngb.org/cnsa/), number CNP0007748. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the National Key Research and Development Program of China (2021YFC2701800, 2021YFC2701805). Authors' contributions liming He, Yibing Cheng and Huang li wrote the manuscript, did the statistical analysis and prepared the tables and graphs. Zhenyu Zhang, Qunqun Zhang, Ling Gong and Tian Li contributed to data collection and provided guidance on data analysis. Xiulan Lu, Xiaodi Cai and Gangfeng Yan designed the study and reviewed the manuscript. All authors reviewed the manuscript and approved the final manuscript. Acknowledgements Not applicable. References Catherinot E, Lanternier F, Bougnoux ME, Lecuit M, Couderc LJ, Lortholary O. 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General information of the patients Variables Total Cases 59(PCP:51, PCC:8) Male,n(%) 42(71.2) Age, months 10(5, 47) Number of people included in each hospital, n Children’s Hospital of Fudan University 42(PCP:40, PCC:2) Henan Children’s Hospita 7( PCP:3, PCC:4 ) Hunan Children’s Hospital 5( PCP:4, PCC:1 ) Guangzhou women and Children’s medical center 5( PCP:4, PCC:1 ) Underlying disease, n Primary immunodeficiency disease 24 Solid tumor 14 Hematologic malignant disease 4 HSCT 2 Solid organ transplantation 3 Rheumatic disease 2 Nephrotic syndrome 2 Inherited metabolic disease 2 Others 8 Fever, n(%) 52(88.1) Mechanical ventilation, n(%) 51(86.4) Co-infection, n(%) 46(78.0) Cytomegalovirus, n(%) 21(35.6) Continued Table 1. General information of the patients Variables Total Epstein-Barr virus, n(%) 6(10.2) Acinetobacter baumannii, n(%) 5(8.5) Mycobacterium tuberculosis, n(%) 4(6.8) Streptococcus pneumoniae, n(%) 4(6.8) Anti-infection adjustment, n(%) 26(44.1) PCP: pneumocystis jirovecii pneumonia; PCC: pneumocystis jirovecii colonisation; HSCT: Hematopoietic stem cell transplantation. Table 2. Comparison between the PCP group and the PCC group Variables PCP PCC Z/t/X 2 P Number n=51 n=8 Age, months 10.00(5.00, 48.50) 7.50(2.50, 31.50) 1.164 0.244 Weight, kg 8.50(6.75, 14.00) 7.50(5.50, 11.50) 0.820 0.412 Male, n(%) 37(72.5) 5(62.5) 0.027 0.870 PELOD-2 zcore 4.32 ± 2.70 3.25 ± 3.95 0.736 0.465 Hosipital stay time, days 34.0(17.5, 48.5) 17.0(13.5, 23.0) 1.816 0.069 PICU stay time, days 21.0(10.5, 37.0) 13.0(7.5, 16.5) 1.600 0.110 Mechanical ventilation time, days 16.00(7.00, 27.00) 7.00(4.00, 11.50) 1.904 0.057 Fever, n(%) 46(90.2) 6(75.0) 0.238 WBC, 10 9 /L 6.10(4.03, 10.20) 8.81(5.72, 11.51) 1.218 0.223 Lymphocyte, 10 9 /L 0.64(0.40, 2.20) 3.14(1.96, 5.69) 2.879 0.004 CRP, mg/L 29.80(8.00, 83.50) 0.99(0.50, 14.93) 2.854 0.004 LDH, U/L 720(539, 978) 372(279, 752) 1.860 0.063 CD3, 10 6 /ml 340(137, 1293) 1311(554, 2886) 1.762 0.078 CD8, 10 6 /ml 184(42, 549) 530(210, 1273) 1.762 0.078 CD4, 10 6 /ml 79(28, 524) 748(185, 1538) 1.872 0.061 Reads number（DNA） 5955(595, 23971) 8(3, 69) 3.717 ＜0.001 BDG, pg/ml 292(161, 600) 48(37, 138) 3.856 ＜0.001 Underlying disease, n(%) Primary immunodeficiency disease 24(47.1) 0(0.0) 4.546 0.033 Solid organ transplantation or HSCT 4(7.8) 1(12.5) 0.531 Solid tumor 14(27.5) 0(0.0) 1.562 0.211 Glucocorticoid, n(%) 37(72.5) 4(50.0) 0.765 0.382 Continued Table 2. Comparison between the PCP group and the PCC group Variables PCP PCC Z/t/X 2 P Number n=51 n=8 Co-infection, n(%) 41(80.4) 5(62.5) 0.458 0.499 Ground-glass opacity 26(51.0) 0(0.0) 5.370 0.020 Caspofungin, n(%) 37(72.5) 2(25.0) 5.017 0.025 Mortality, n(%) 18(35.3) 2(25.0) 0.029 0.865 Data are presented as mean ± SD, median (P 25 , P 75 ) or number (%). PCP: pneumocystis jirovecii pneumonia; PCC: pneumocystis jirovecii colonisation; PELOD-2: Pediatric logistic organ dysfunction score 2; PICU: Pediatric intensive care unit; WBC: White blood cell; CRP: C-reactive protein; LDH: Lactic dehydrogenase; BDG: 1,3-β-D-glucan; HSCT: Hematopoietic stem cell transplantation. Table 3. Comparison of patients with different outcomes at discharge in PCP group Variables Non-survivors Survivors Z/t/X 2 P Number 18 33 Age, months 6.00(4.75, 21.50) 20.00(5.50, 67.00) 2.015 0.044 Weight, kilograms 7.50(5.88, 9.63) 11.00(7.00, 16.75) 2.061 0.039 Male, n(%)） 12(66.7) 25(75.8) 0.135 0.714 PELOD-2 score 5.50 ± 2.64 3.59 ± 2.50 2.497 0.016 Hosipital stay time, days 20.5(9.5, 42.0) 38.0(22.5, 55.0) 2.277 0.023 PICU stay time, days 16.0(8.5, 34.0） 21.0(11.5, 40.5) 1.183 0.237 Mechanical ventilation time, days 13.00(6.00, 32.00) 19.00(8.00, 23.00) 0.418 0.676 Fever, n(%) 17(94.4) 29(87.9) 0.068 0.794 WBC, 10 9 /L 7.40(4.87, 10.30) 5.40(3.28, 11.00) 0.857 0.391 Lymphocyte, 10 9 /L 0.71(0.47, 1.81) 0.61(0.29, 3.07) 0.345 0.730 CRP, mg/L 33.27(8.32, 83.95) 28.00(5.32, 89.50) 0.850 0.395 LDH, U/L 814(612, 1340) 687(476, 916) 1.666 0.096 CD3, 10 6 /ml 126(51, 590) 542(234, 1721) 2.964 0.003 CD8, 10 6 /ml 60(6, 120) 262(121, 635) 3.460 0.001 CD4, 10 6 /ml 38(4, 65) 268(64, 1015) 3.137 0.002 CD4 ratio 14.55(2.10, 32.57) 27.91(15.10, 45.53) 2.350 0.019 Reads number（DNA） 4838(1285, 15329) 10359(371, 40994) 0.294 0.769 BDG, pg/ml 185(151, 320) 455(171, 675) 2.250 0.024 Underlying disease, n(%) Primary immunodeficiency disease 13(72.2) 11(33.3) 7.070 0.008 Solid tumor 3(16.7) 11(33.3) 0.895 0.344 Solid organ transplantation or HSCT 1(5.6) 3(9.1) 0.000 1.000 Glucocorticoid, n(%) 13(72.2) 24(72.7) 0.000 1.000 Continued Table 3. Comparison of patients with different outcomes at discharge in PCP group Variables Non-survivors Survivors Z/t/X 2 P Number 18 33 Co-infection, n(%) 14(77.8) 27(81.8) 0.000 1.000 Ground-glass opacity 10(35.7) 25(40.3) 0.476 0.490 Data are presented as mean ± SD, median (P 25 , P 75 ) or number (%). PCP: pneumocystis jirovecii pneumonia; PELOD-2: Pediatric logistic organ dysfunction score 2; PICU: Pediatric intensive care unit; WBC: White blood cell; CRP: C-reactive protein; LDH: Lactic dehydrogenase; BDG: 1,3-β-D-glucan; HSCT: Hematopoietic stem cell transplantation. Table 4. Comparison of primary immunodeficiency and secondary immunodeficiency in PCP group Variables primary immunodeficiency Secondary immunodeficiency Z/t/X 2 P Number 24 27 Age, months 6.00(4.00, 8.50) 41.00(15.50, 67.00) 3.659 0.000 Weight, kg 7.00(5.90, 8.15) 12.60(9.00, 16.75) 3.815 0.000 Male, n(%) 18(75.0) 19(70.4) 0.137 0.712 PELOD-2 score 4.55 ± 3.07 4.12 ± 2.37 0.536 0.595 Hosipital stay time, days 37.5(17.0, 48.0) 31.0(17.5, 51.0) 0.444 0.657 PICU stay time, days 21.0(11.5, 35.5 ) 18.0(9.5, 39.0) 0.019 0.985 Mechanical ventilation time, days 19.0(9.0, 32.0) 14.0(6.0, 21.0) 1.445 0.148 Fever, n(%) 22(91.7) 24(88.9) 0.000 1.000 WBC, 10 9 /L 8.31(5.22, 12.20) 4.60(3.03, 8.22) 2.321 0.020 Lymphocyte, 10 9 /L 1.41(0.49, 2.80) 0.59(0.28, 1.13) 2.161 0.031 IL-6, ng/L 25.2(8.2, 113.6) 119.0(29.1, 276.2) 2.191 0.028 CD3, 10 6 /ml 579(51, 1398) 274(179, 1293) 0.227 0.821 CD8 , 10 6 /ml 139(12, 551) 191(96, 516) 0.928 0.353 CD4 , 10 6 /ml 175(12, 728) 77(35, 524) 0.144 0.885 CD4/CD8 1.70(1.00, 2.59) 0.77(0.31, 1.57) 2.516 0.012 Reads number（DNA） 8138(1642, 23591) 5431(590, 26679) 0.511 0.609 BDG, pg/ml 224(164, 521) 374(159, 619) 0.642 0.521 Mortality, n(%) 13(54.2) 5(18.5) 7.070 0.008 Data are presented as mean ± SD, median (P 25 , P 75 ) or number (%). PCP: pneumocystis jirovecii pneumonia; PELOD-2: Pediatric logistic organ dysfunction score 2; PICU: Pediatric intensive care unit; WBC: White blood cell; IL-6: Interleukin-6; BDG: 1,3-β-D-glucan; Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7061414","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":502646341,"identity":"e7c1d684-0ba4-484b-b78b-d9af5740ef42","order_by":0,"name":"Liming He","email":"","orcid":"","institution":"Children’s Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Liming","middleName":"","lastName":"He","suffix":""},{"id":502646342,"identity":"a805a436-8d9e-4e24-9716-cad648949098","order_by":1,"name":"Yibing Cheng","email":"","orcid":"","institution":"Henan Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yibing","middleName":"","lastName":"Cheng","suffix":""},{"id":502646343,"identity":"17b63ac6-caa1-4735-86a0-8ec10cfad2be","order_by":2,"name":"Li Huang","email":"","orcid":"","institution":"Guangzhou Women and Children’s medical center, Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Huang","suffix":""},{"id":502646344,"identity":"6ac38366-325e-4e49-ab1d-77dcfa09b16c","order_by":3,"name":"Zhenyu Zhang","email":"","orcid":"","institution":"Children’s Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Zhenyu","middleName":"","lastName":"Zhang","suffix":""},{"id":502646345,"identity":"b9821e18-6323-4088-817c-5e5fcaf8fef3","order_by":4,"name":"Qunqun Zhang","email":"","orcid":"","institution":"Henan Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qunqun","middleName":"","lastName":"Zhang","suffix":""},{"id":502646346,"identity":"2ac48f04-427b-4798-83a7-396cb87b0c70","order_by":5,"name":"Ling Gong","email":"","orcid":"","institution":"Hunan Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ling","middleName":"","lastName":"Gong","suffix":""},{"id":502646347,"identity":"b79674f6-5c92-46be-84a8-a25997010eb9","order_by":6,"name":"Tian Li","email":"","orcid":"","institution":"Guangzhou Women and Children’s medical center, Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tian","middleName":"","lastName":"Li","suffix":""},{"id":502646348,"identity":"4b118afa-eacb-47f6-9d75-eb15d624e559","order_by":7,"name":"Xiulan Lu","email":"","orcid":"","institution":"Hunan Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiulan","middleName":"","lastName":"Lu","suffix":""},{"id":502646349,"identity":"ade513e1-87ff-449d-bd65-23fff2cc640a","order_by":8,"name":"Xiaodi Cai","email":"","orcid":"","institution":"Children’s Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Xiaodi","middleName":"","lastName":"Cai","suffix":""},{"id":502646350,"identity":"b5407b81-766d-4336-8ac5-25e7bd58e8ec","order_by":9,"name":"Gangfeng Yan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABG0lEQVRIiWNgGAWjYLCCChjjgw0DYwOIwUNIyxkozTgjjVQtzDzEaJF3P3v4xYGKO3YNEsnPHtskHJbtn93A+OBtG4O8OQ4thmfy0iwOnHmW3CCRZm6ck3DYeMadA8yGc9sYDHc24NDSkGNm/LHtcDKDRIKZdO6Pw4kNNxLYpHnbGBIMDuDQ0v/GzODgP5CW9G/SFgmHE+ffSGD/jU+LvESO8YODDYftGCRyzKQZgFo2AG1hxqfFQOKNGcOBY4cTGHjelEn2JKQbb7yR2Cw555yE4QZctvTnGH84UHPYnoE9fZvEjwRr2Xk3kg9+eFNmI4/TlgMMbBJAOnH/hQSYGDhqJLCrB9nSwMD8AUjbM/DjMHQUjIJRMApGAQBdVmRsho3oUgAAAABJRU5ErkJggg==","orcid":"","institution":"Children’s Hospital of Fudan University","correspondingAuthor":true,"prefix":"","firstName":"Gangfeng","middleName":"","lastName":"Yan","suffix":""}],"badges":[],"createdAt":"2025-07-07 05:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7061414/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7061414/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12890-026-04163-9","type":"published","date":"2026-02-07T15:59:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89564371,"identity":"fa5b8437-b61e-4bae-a333-ce640e1efa5e","added_by":"auto","created_at":"2025-08-21 10:34:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":97077,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow diagram of the patients included in the study. \u003c/strong\u003ePICU: pediatric intensive care unit ; BALF: bronchoalveolar lavage fluid; mNGS: \u0026nbsp;metagenomic next-generation sequencing; PJ: Pneumocystis jirovecii; HIV: human immunodeficiency virus; PCP: pneumocystis jirovecii pneumonia; PCC: pneumocystis jirovecii colonisation;\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7061414/v1/8464fa068f9997c07cb3b378.png"},{"id":89564373,"identity":"94f79a02-404d-4520-86eb-115afeeee4b9","added_by":"auto","created_at":"2025-08-21 10:34:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":187233,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReceiver operating characteristic curve (ROC) of metagenomic next-generation sequencing (mNGS) for discrimination between pneumocystis jirovecii pneumonia and pneumocystis colonization\u003c/strong\u003e.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7061414/v1/33dcf9337263fc1312c0c435.png"},{"id":102235825,"identity":"c978850a-949a-4946-8e31-6c42455846e5","added_by":"auto","created_at":"2026-02-09 16:17:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1585060,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7061414/v1/22bda436-9b02-4d55-95e3-97fd5a33584c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A retrospective, multicenter study on the pneumocystis jirovecii pneumonia in critically ill children with non-human immunodeficiency virus using metagenomics next-generation sequencing","fulltext":[{"header":"Background","content":"\u003cp\u003ePneumocystis jirovecii (PJ) is an opportunistic pathogen that can cause pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. PCP used to occur among the human immunodeficiency virus (HIV)-infected persons. In recent years, after the introduction of the highly effective antiretroviral treatment for HIV, and the widespread use of immunosuppressants and/or chemotherapeutics in patients with solid tumors, hematologic malignant disease, rheumatic diseases, and other diseases, the incidence of PCP in HIV-infected patients has significantly decreased, while the incidence among non-HIV-infected immunocompromised patients has increased year by year\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The non-HIV-infected patients with PCP usually develop an acute course of disease with a higher mortality (28\u0026ndash;53%) than the HIV-infected patients (17\u0026ndash;30%)\u003csup\u003e4\u0026ndash;6\u003c/sup\u003e. The main symptoms include fever, dry cough, chest pain, and dyspnea. The typical radiological features are bilateral, diffuse ground-glass opacity, accompanied by slab stone signs, patchy shadows, interstitial changes, and pneumonectasis\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe prognosis of PCP in non-HIV patients depends on early diagnosis, early treatment, early appropriate prophylaxis for high-risk populations, and early identification of severe cases\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. PJ mainly parasitizes the pulmonary alveoli in the form of cysts and trophozoites. The gold standard for the diagnosis of PCP has been the microscopic visualization of cysts and trophozoites in respiratory specimens such as BALF or sputum. Due to its low sensitivity, the positive rate was low\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. With the rapid development of metagenomic next-generation sequencing (mNGS) technology to detect target organisms in critically ill patients, articles on the application of mNGS technology to detect PCP have emerged\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. However, to our knowledge, articles on the performance of mNGS for diagnosis of PCP by BALF in non-HIV critically pediatric patients were few and they all have been small sample, single-center studies\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Based on it, we designed a multicenter, retrospective study that enrolled non-HIV children with PCP infection admitted in pediatric intensive care unit (PICU) of four children\u0026rsquo;s hospitals, between January 2019 and May 2023. We aimed to analyze the clinical characteristics of non-HIV children with PCP and to evaluate the value of mNGS of BALF in diagnosing PCP in non-HIV critically pediatric patients.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003eStudy population\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this multicenter, retrospective study, we enrolled patients who were admitted to the PICU of Children\u0026rsquo;s Hospital of Fudan University, Guangzhou Women and Children\u0026rsquo;s Medical Center, Henan Children\u0026rsquo;s Hospital and Hunan Children\u0026rsquo;s Hospital from January 2019 to May 2023. These patients underwent mNGS of BALF for severe pneumonia and were treated with trimethoprim/sulfamethoxazole (TMP/SMZ) when the PCP was confirmed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion and exclusion criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAccording to the revised EORTC/MSGERC consensus definitions of PCP in individuals without HIV and the results of mNGS of BALF, the patients were divided into the probable PCP (PCP) group and pneumocystis jirovecii colonization (PCC)group \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Probable PCP was defined by the appropriate host factors, clinical and radiologic criteria, blood 1,3-β-D-glucan (BDG) positive twice and the detection of PJ by mNGS in the BALF. The PCC group was defined by the detection of PJ by mNGS in the BALF without appropriate host factors, or clinical and radiologic appearance. The details were as follows: (1) immunosuppressed hosts without HIV infection; (2) cough, fever, and shortness of breath; (3) radiological appearance of diffuse ground-glass opacity with interstitial infiltrates, consolidated or reticulate shadows in both lungs; (5) blood BDG\u0026thinsp;\u0026ge;\u0026thinsp;100 pg/ml twice; (4) detection of PJ by mNGS in the BALF. Grouping patients based on the above criteria was made after discussion with the medical team. The exclusion criteria were (1) HIV infection; (2) mNGS sample was not from BALF; (3) incomplete medical record.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBALF collection and preservation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe BALF was collected by experienced respiratory therapists according to the guidelines \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. The quality requirements for the BALF samples were as follows: (1) a\u0026thinsp;\u0026ge;\u0026thinsp;40% recovery rate; (2) without mixture with blood (\u0026lt;\u0026thinsp;10% red blood cells); (3) collection of lavage fluid from diseased lung segments based on recent chest CT results or from the right middle lobe for the diffuse lung disease; (4)lavage volume: 1ml/kg for each time, \u0026le;\u0026thinsp;20 mL for each time, and \u0026le;\u0026thinsp;5\u0026ndash;10 mL/kg for total fluid; The samples were collected in a sterile container and sent for analysis within 2 hours. For specimens that could not be sent in time, they could be stored in a 4-degree refrigerator and analyzed within 24 hours.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMetagenomic Next-Generation Sequencing Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe performed mNGS regarding our previously published studies\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Briefly, It included 1) DNA extraction and pretreatment: A 0.6-3 ml BALF was inactivated and mixed with the glass grinding beads to do the wall breaking process. Then the DNA was extracted using the TIANamp Micro DNA Kit (No. DP316, Tiangen Biochemical Technology, Beijing, China) according to the kit instructions. 2) Library construction: First, the end repair, ligation and PCR amplification of the DNA fragments were performed using the MGIEasy Cell-free DNA Library Prep Kit (MGI tech, Shenzhen, China) according to the manufacturer's kit; Then, the libraries were quality controlled using the 2100 Bioanalyzer (Agilent, USA) with a qualified library fragment size of 200\u0026ndash;300 bp, and a Qubit dsDNA HS Assay Kit (Thermo Fisher Scientific, USA) for DNA library concentration of \u0026gt;\u0026thinsp;2 ng/\u0026micro;L; Finally, the different samples were mixed in equal amounts of nucleic acid for subsequent operations. 3) High throughput sequencing: High-throughput sequencing is done by BGISEQ-50 (MGI tech, Shenzhen, China) referring to the manufacturer's instructions. 4) Sequencing data pre-processing: The sequencing data obtained were first subjected to data quality control to remove low quality and reads with sequence lengths less than 35bp reads to obtain high quality reads; The high quality reads were then compared to the human reference genome (version hg19) by BWA software (version 0.7.15-r1140) to remove contamination from human-derived sequences; The remaining data were based on prinseq software (version 0.20.4) after removing repetitive, low-complexity sequences, and then aligned to the PMDB pathogen database (BGI's internal database of 4945 viruses, 6039 bacteria (excluding Mycobacterium), 174 Mycobacterium, 137 Mycoplasma, Chlamydia 1064 fungi and 234 parasites associated with human diseases); The microbial sequence data obtained after the alignment were annotated according to viruses, bacteria, fungi and parasites.\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical data collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe recorded patient data including demographics, underlying diseases, clinical symptoms, and signs, laboratory test results and radiological results within one week of positive PJ mNGS, pediatric logistic organ dysfunction-2 (PELOD-2) score when inpatient, previous use of glucocorticoids or immunosuppressants, time from onset to use of TMP/SMZ, pathogen test results, and discharge outcomes.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAnalyses were carried out using the SPSS version 23.0 platform (SPSS, Inc., Chicago, IL, USA). Normally distributed variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and were compared using a student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test. Nonparametric continuous variables were presented as median (interquartile range) values and compared using a Mann\u0026ndash;Whitney \u003cem\u003eU\u003c/em\u003e-test. Categorical variables were expressed as percentages and compared using an χ\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e test or Fisher exact probability. A multivariate logistic regression analysis was done for mortality factors. The receiver operating characteristic curve (ROC) analysis was employed to assess the value of BALF mNGS in differentiating between PJ infection and colonization. The Yuden index was used to determine the optimal threshold and its sensitivity and specificity. A value of \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePopulation Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs Figure 1 showed, from January 2019 to May 2023, we identified 86 mNGS PJ positive children in the above four PICUs of Children\u0026rsquo;s Hospitals. One of them was infected with HIV and one\u0026rsquo;s sample was from blood, then excluded from the study. Twenty- five patients were excluded for the missing original reports. We finally enrolled 59 pediatric patients. According to the 2021 EORTC/MSGERC definition of PCP and the results of mNGS, the cases were classified into the PCP group (n=51) and the PCC group (n=8). The number of patients included in each hospital was: 42 in the Children\u0026rsquo;s Hospital of Fudan University (40 occurred PCP and 2 occurred PCC), 5 in the Guangzhou Women and Children\u0026rsquo;s Medical Center (4 occurred PCP and 1 occurred PCC), 5 in the Human Children\u0026rsquo;s Hospital (4 occurred PCP and 1 occurred PCC) and 7 in the Henan Children\u0026rsquo;s Hospital (3 occurred PCP and 4 occurred PCC). 42 out of 51 patients (71.2%) were males. The age ranged from two months to fourteen years (the median age was ten months). The underlying disease included the primary immunodeficiency disease (n=24), solid tumor (n=14), hematologic malignant diseases (n=4), hematopoietic stem cell transplantation (HSCT) (n=2), solid organ transplantation (n=3), rheumatic disease (n=2), nephrotic syndrome (n=2), inherited metabolic disease (n=2) and so on. Fifty two cases (88.1%) run fever. \u0026nbsp; The number of patients requiring invasive/ non-invasive mechanical ventilation was 51 cases (86.4%). Co-infections were detected in 46/59 (78.0%) children. The top five pathogens were Cytomegalovirus (n=21, 35.6%), Epstein-Barr virus (n=6, 10.2%), Acinetobacter baumannii (n=5, 8.5%), Mycobacterium tuberculosis (n=4, 6.8%), Streptococcus pneumoniae (n=4, 6.8%). \u0026nbsp;The results were shown in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison between the PCP group and the PCC group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the definition of PCP in this study, we classified the enrolled patients into the PCP group (n= 51) and the PCC group (n= 8). When compared with the PCC group, peripheral blood lymphocytes were significantly lower in PCP patients (p=0.004). C-reactive protein (CRP) was significantly higher in PCP patients (p=0.004). The median of BDG was significantly higher in PCP patients than that in the PCC patients (p＜0.001). Lactic dehydrogenase\u0026nbsp;(LDH) in the PCP and PCC group were\u0026nbsp;720(539, 978)\u0026nbsp;\u0026mu;/l\u0026nbsp;and 372(279, 752)\u0026nbsp;\u0026mu;/l\u0026nbsp;respectively, which was higher in the PCP group\u0026nbsp;but with no statistical significance.\u0026nbsp;Meanwhile\u0026nbsp;the count of CD regulatory T cells (CD3, CD4, and CD8) was lower in the PCP group than those in the PCC group, but with no statistical significance (p=0.078, 0.061, and 0.078, respectively). The median mNGS read number of PJ was significantly higher in the PCP group than in the PCC group (5955 vs. 8, p＜0.001). The area under the curve was 0.937 (95%CI: 0.865\u0026ndash;1.000) for mNGS read number of PJ in BALF (Figure 2). The optimal threshold value for discriminating PJ infection from colonization appeared to be 556 reads (sensitivity, 77.6%; specificity, 100.0%) When the Youden index was at its maximum (0.776). For\u0026nbsp;underlying diseases, the proportion of patients with primary immunodeficiency in the PCP group was significantly higher than that in the PCC group (p=0.033).\u0026nbsp;Diffuse ground-glass opacity was\u0026nbsp;significantly more common in the PCP group (p=0.020). The combination therapy of caspofungin and TMP/SMZ was higher in the PCP group\u0026nbsp;(p=0.025). There was no statistically significant difference between the two groups in terms of age, weight, and gender (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of patients with different outcomes at discharge in the PCP group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe classified the PCP patients into non-survivors (n=18) and survivors (n=33) at discharge and analyzed the prognosis factor of PCP. Compared with the survivors, the non-survivors had younger ages, lower weight, and shorter\u0026nbsp;hospital\u0026nbsp;stays (all p＜0.05). The CD3 counts in the\u0026nbsp;non-survivors and survivors were 126(51, 590) cells/\u0026mu;l and 542(234, 1721)\u0026nbsp;cells/\u0026mu;l respectively, CD4\u0026nbsp;counts were\u0026nbsp;38(4, 65) cells/\u0026mu;l and 268(64, 1015) cells/\u0026mu;l, CD8 counts were 60(6, 120) cells/\u0026mu;l and 262(121, 635)cells/\u0026mu;l, CD4 ratio was 14.55(2.10, 32.57) and 27.91(15.10, 45.53), which were all significantly lower in the non-survivors than these in the survivors (all p＜0.05).\u0026nbsp;\u0026nbsp;The proportion of patients with primary immunodeficiency in the\u0026nbsp;non-survivors\u0026nbsp;was significantly higher than that in the\u0026nbsp;survivors\u0026nbsp;(p=0.008). \u0026nbsp;The PELOD-2 score at admission was also significantly higher in the\u0026nbsp;non-survivors\u0026nbsp;than in the\u0026nbsp;survivors\u0026nbsp;(p=0.016) \u0026nbsp;(Table 3). A\u0026nbsp;multivariable logistic analysis showed age, weight, CD counts (CD3, CD4, CD8, and CD4 ratio),\u0026nbsp;the PELOD-2 score at admission, and the proportion of primary immunodeficiency were all not related to the prognosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of primary immunodeficiency patients and secondary immunodeficiency patients in PCP group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe divided the PCP group into the primary immunodeficiency (n=24) and secondary immunodeficiency (n=27) groups according to the basic disease and analyzed the difference between them. When compared with the secondary immunodeficiency group, the primary immunodeficiency group had a younger age, lower weight, higher white cell counts and lymphocyte counts, and lower IL-6 expression (all p＜0.05). The CD4 counts in the primary and secondary immunodeficiency groups were 175(12, 728) cells/\u0026mu;l and 77(35, 524) cells/\u0026mu;l respectively, the median were all below 200 cells/\u0026mu;l. The CD4/CD8 ratio was higher in the primary immunodeficiency group than in the secondary immunodeficiency group (p=0.012). The mortality at discharge was significantly higher in the primary immunodeficiency group than in the secondary immunodeficiency group (54.2% vs. 18.5%, p=0.008). There was no statistical significance in the hospital stay, PICU stay, Invasive/non-invasive mechanical ventilation rate, and the number of PJ reads in the BALF mNGS and BDG between the two groups (Table 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePneumocystis jirovecii is a life-threatening opportunistic pathogen and an important cause of severe pneumonia in immunocompromised children\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Accurate and timely diagnosis is the most important factor for improving PCP-related mortality in individuals with non-HIV infection. PJ mainly parasitizes the pulmonary alveoli in the form of cysts and trophozoites. It cannot be cultured in vitro so far, and the detection rate of existing methods is low\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. As a rapid, unbiased pathogen detection technology, mNGS has the advantages of high sensitivity, comprehensive, and timely identifying pathogen infection in critically ill children\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. In this multicenter retrospective observational study, we finally enrolled 59 BALF PJ positive children using mNGS technology and timely adjusted anti-infective therapeutic schemes for 26 patients (44.1%). The mortality was 33.9% at discharge, while the reported mortality of non-HIV PCP children ranged from 11.8\u0026ndash;41.7%\u003csup\u003e10,11,19\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSolid tumors and hematologic malignancies are the most common basic diseases in most of the studies for PCP-infected adults with non-HIV infection\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. However, in our study, about 47.1% (24/51) of PCP children were primary immunodeficiency disease. Differences in the spectrum of diseases in adults and children might contribute to this result. The children with primary immunodeficiency disease had younger age, lower weight, and significantly higher mortality than those with secondary immunodeficiency disease. It indicated that the primary immunodeficiency children with PCP may have a poor prognosis. Appropriate prophylaxis should be considered in primary immunodeficiency disease children.\u003c/p\u003e\u003cp\u003e We classified the enrolled patients into the PCP group (n\u0026thinsp;=\u0026thinsp;51) and the PCC group (n\u0026thinsp;=\u0026thinsp;8) according to the definition of PCP in our study. When compared with the PCC group, the PCP group had lower lymphocyte numbers, higher CRP, a higher proportion of primary immunodeficiency disease, a higher imaging change of ground-glass opacity on CT scans, higher BDG results and higher median mNGS reads number of PJ (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). While in Li Liu and his colleagues\u0026lsquo;s study, they found that the PCP group had higher levels of LDH and CRP than those in the PCC group \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWhen compared with the survivors, non-survivors of PCP infections had younger age, lower CD regulatory T cell counts (CD3, CD4, and CD8), higher proportion of primary immunodeficiency disease, and higher PELOD-2 score. In comparison, a multivariable logistic analysis detected no risk factor for a poor prognosis. Chen Ling and her colleagues reported that compared with the survivors, the non-survivors with PCP in non-HIV children also had younger ages and a higher proportion of primary immunodeficiency disease. At the same time, the LDH level, co-infection, and need for mechanical ventilation were the risk factors for a poor prognosis of PCP\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Differences in the spectrum of diseases might contribute to part of the difference.\u003c/p\u003e\u003cp\u003eFor patients with impaired immune function, the probability of mixed infections of multiple pathogens in the lungs is significantly increased. In this study, about 78.0% of enrolled patients had mixed infections. Among the mixed infections, CMV was the most common pathogen which was consistent with previous related studies\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe mNGS technology has the advantage of unbiased sequencing by extracting total DNA or RNA, fragmentation, library preparation, and deep sequencing from original samples\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. As a rapid, unbiased pathogen detection technology, mNGS has the advantages of comprehensive, rapid, and high sensitivity in the diagnosis of PJ infection. However, blind treatment based on mNGS lonely is inappropriate, since mNGS technology cannot distinguish pathogens between colonization and infection. At the same time, due to its high sensitivity, false positive results may occur, while incomplete wall breaking may lead to false negative results\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. In our study, the number of mNGS reads for PJ was significantly higher in the PCP group than in the PCC group. The optimal threshold values for discriminating PJ infection from colonization appeared to be 556 reads (sensitivity, 77.6%; specificity, 100.0%). In Li Liu and his colleagues\u0026rsquo; study on PCP-infected adults, they showed that the optimal threshold was 14 reads with a sensitivity of 83.3% and specificity of 95.7% \u003csup\u003e22\u003c/sup\u003e. Different subjects and underlying diseases might arrive at different results. BALF mNGS may be a useful technology that can assist with distinguishing between infection and colonization of PJ, but more research is needed to determine the cut-off values.\u003c/p\u003e\u003cp\u003eOur study has some limitations. Firstly, this was a retrospective study relying on existing medical records that were not enough to meet the requirements of the investigation. Secondly, we enrolled a relatively small sample size due to the incomplete medical records. A larger study sample is needed to confirm our results. Finally, whether prophylactic use of TMP/SMZ before BALF collection was not distinguished. It might influence the reads of BALF mNGS.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe mNGS technology is an efficient and useful diagnostic technology for PCP in critically pediatric patients. BALF samples for mNGS are recommended for the presumptive diagnosis of PCP. BALF mNGS may help distinguish infection from colonization of PJ but more research is needed to verify.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePJ Pneumocystis jirovecii \u003c/p\u003e\n\u003cp\u003ePCP Pneumocystis jirovecii pneumonia\u003c/p\u003e\n\u003cp\u003eHIV Human immunodeficiency virus\u003c/p\u003e\n\u003cp\u003emNGS Metagenomic next-generation sequencing\u003c/p\u003e\n\u003cp\u003eBALF Bronchoalveolar lavage fluid\u003c/p\u003e\n\u003cp\u003ePCC Pneumocystis jirovecii colonization\u003c/p\u003e\n\u003cp\u003eCRP C-reactive protein\u003c/p\u003e\n\u003cp\u003ePICU Pediatric intensive care unit\u003c/p\u003e\n\u003cp\u003eTMP/SMZ Trimethoprim/sulfamethoxazole\u003c/p\u003e\n\u003cp\u003eBDG 1,3-\u0026beta;-D-glucan\u003c/p\u003e\n\u003cp\u003ePELOD-2 Pediatric logistic organ dysfunction-2\u003c/p\u003e\n\u003cp\u003eROC Receiver operating characteristic curve\u003c/p\u003e\n\u003cp\u003eHSCT Hematopoietic stem cell transplantation\u003c/p\u003e\n\u003cp\u003eLDH Lactic dehydrogenase\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethics committee approved this study at the Children\u0026rsquo;s Hospital of Fudan University with an IRB of 2019 \u0026minus; 312.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInformed consent to participate was taken from parents/legal guardians of minor participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The datasets generated and/or analysed during the current study are available in the China National GeneBank Sequence Archive (CNSA), (https://db.cngb.org/cnsa/), number CNP0007748.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the National Key Research and Development Program of China (2021YFC2701800, 2021YFC2701805).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eliming He, Yibing Cheng and Huang li wrote the manuscript, did the statistical analysis and prepared the tables and graphs. Zhenyu Zhang, Qunqun Zhang, Ling Gong and \u0026nbsp;Tian Li contributed to data collection and provided guidance on data analysis. Xiulan Lu, Xiaodi Cai and Gangfeng Yan designed the study and reviewed the manuscript. All authors reviewed the manuscript and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCatherinot E, Lanternier F, Bougnoux ME, Lecuit M, Couderc LJ, Lortholary O. Pneumocystis jirovecii Pneumonia. Infect Dis Clin North Am. 2010, 24(1):107-138.\u003c/li\u003e\n\u003cli\u003eSalzer HJF, Sch\u0026auml;fer G, Hoenigl M, G\u0026uuml;nther G, Hoffmann C, Kalsdorf B, et al. Clinical, diagnostic, and treatment disparities between HIV-infected and non-HIV-infected immunocompromised patients with pneumocystis jirovecii pneumonia. Respiration. 2018, 96(1):52-65.\u003c/li\u003e\n\u003cli\u003eCill\u0026oacute;niz C, Domined\u0026ograve; C, \u0026Aacute;lvarez-Mart\u0026iacute;nez MJ, Moreno A, Garc\u0026iacute;a F, Torres A, et al. Pneumocystis pneumonia in the twenty-first century: HIV-infected versus HIV-uninfected patients. Expert Rev Anti Infect Ther. 2019, 17(10):787-801.\u003c/li\u003e\n\u003cli\u003eCordonnier C, Cesaro S, Maschmeyer G, Einsele H, Donnelly JP, Alanio A, et al. Pneumocystis jirovecii pneumonia: still a concern in patients with haematological malignancies and stem cell transplant recipients. J Antimicrob Chemother. 2016, 71(9):2379-2385.\u003c/li\u003e\n\u003cli\u003eBraga BP, Prieto-Gonz\u0026aacute;lez S, Hern\u0026aacute;ndez-Rodr\u0026iacute;guez J. Pneumocystis jirovecii pneumonia prophylaxis in immunocompromised patients with systemic autoimmune diseases. Med Clin (Barc). 2019, 152(12):502-507.\u003c/li\u003e\n\u003cli\u003eLagrou K, Chen S, Masur H, Viscoli C, Decker CF, Pagano L,et al. Pneumocystis jirovecii disease: basis for the revised EORTC/MSGERC invasive fungal disease definitions in individuals without human immunodeficiency virus. Clin Intect Dis. 2021, 72(Supplement_2):S114-S120.\u003c/li\u003e\n\u003cli\u003eJiang J, Bai L, Yang W, Peng W, An J, Wu Y, et al. Metagenomic next-generation sequencing for the diagnosis of pneumocystis jirovecii pneumonia in non-HIV-infected patients: A retrospective study. Infect Dis Ther. 2021, 10(3):1733-1745.\u003c/li\u003e\n\u003cli\u003ePan T, Tan R, Qu H, Weng X, Liu Z, Li M, et al. Next-generation sequencing of the BALF in the diagnosis of community-acquired pneumonia in immunocompromised patients. J Infect. 2019, 79(1):61-74.\u003c/li\u003e\n\u003cli\u003eZhang F, Chen J, Huang H, Deng X, Zhang W, Zeng M, et al. Application of metagenomic next-generation sequencing in the diagnosis and treatment guidance of Pneumocystis jirovecii pneumonia in renal transplant recipients. Eur J Clin Microbiol. 2021, 40(9):1933-1942.\u003c/li\u003e\n\u003cli\u003eLiu Y, Zhu H, Zheng Y. Detection of pneumocystis jirovecii pneumonia in infants with non-human immunodeficiency virus admitted to pediatric intensive care using metagenomics next-generation sequencing. Infect Drug Resist. 2022, 15:1889-1902.\u003c/li\u003e\n\u003cli\u003eChen H, Liang Y, Wang R, Wu Y, Zhang X, Huang H, et al. Metagenomic next-generation sequencing for the diagnosis of Pneumocystis jirovecii Pneumonia in critically pediatric patients. Ann Clin Microb Anti. 2023, 22(1).\u003c/li\u003e\n\u003cli\u003ede Blic J, Midulla F, Barbato A, Clement A, Dab I, Eber E, et al. Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society. Eur Respir J. 2000, 15(1):217-231.\u003c/li\u003e\n\u003cli\u003eWang Y, Wang W, Yi B, Feng Z, Yang K. Clinical practice guidelines for bronchoalveolar lavage in Chinese children (2024). Chin J Contemp Pediatr. 2024; 26(01): 1-13.\u003c/li\u003e\n\u003cli\u003eYan G, Liu J, Chen W, Chen Y, Cheng Y, Tao J, et al. Metagenomic next-generation sequencing of bloodstream microbial cell-free nucleic acid in children With suspected sepsis in pediatric intensive care unit. Front Cell Infect Mi. 2021, 11.\u003c/li\u003e\n\u003cli\u003eZhang C, Liu T, Wang Y, Chen W, Liu J, Tao J, et al. Metagenomic next-generation sequencing of bronchoalveolar lavage fluid from children with severe pneumonia in pediatric intensive care unit. Front Cell Infect Mi. 2023, 13.\u003c/li\u003e\n\u003cli\u003eZakrzewska M, Roszkowska R, Zakrzewski M, Maciorkowska E. Pneumocystis pneumonia: still a serious disease in children. J Mother Child 2021, 23(3):159-162.\u003c/li\u003e\n\u003cli\u003eYang A, Chen C, Hu Y, Zheng G, Chen P, Xie Z, et al. Application of metagenomic next-generation sequencing (mNGS) using bronchoalveolar lavage fluid (BALF) in diagnosing pneumonia of children. Microbiol Spectr. 2022, 10(5):e148822.\u003c/li\u003e\n\u003cli\u003eLin P, Chen Y, Su S, Nan W, Zhou L, Zhou Y, et al. Diagnostic value of metagenomic next-generation sequencing of bronchoalveolar lavage fluid for the diagnosis of suspected pneumonia in immunocompromised patients. BMC Infect Dis. 2022, 22(1):416.\u003c/li\u003e\n\u003cli\u003eLing C, Qian S, Wang Q, Zeng J, Jia X, Liu J, et al. Pneumocystis pneumonia in non-HIV children: a 10-year retrospective study. Clin Respir J. 2018, 12(1):16-22.\u003c/li\u003e\n\u003cli\u003eKaplan JE, Benson C, Holmes KK, Brooks JT, Pau A, Masur H. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009, 58(RR-4):1-207, E1-E4.\u003c/li\u003e\n\u003cli\u003eStern A, Green H, Paul M, Vidal L, Leibovici L: Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Db Syst Rev. 2014, 2014(10):D5590.\u003c/li\u003e\n\u003cli\u003eLiu L, Yuan M, Shi Y, Su X. Clinical performance of BAL metagenomic next-generation sequence and serum (1,3)-\u0026beta;-D-Glucan for differential diagnosis of pneumocystis jirovecii pneumonia and pneumocystis jirovecii colonisation. Front Cell Infect Mi. 2021, 11.\u003c/li\u003e\n\u003cli\u003eSimner PJ, Miller S, Carroll KC. Understanding the promises and hurdles of metagenomic next-generation sequencing as a diagnostic tool for infectious diseases. Clin Infect Dis. 2018, 66(5):778-788.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. General information of the patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eCases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e59(PCP:51, PCC:8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eMale,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e42(71.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eAge, months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e10(5, 47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of people included in each hospital, n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cem\u003eChildren\u0026rsquo;s Hospital of Fudan University\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cem\u003e42(PCP:40, PCC:2)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eHenan Children\u0026rsquo;s Hospita\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e7(\u003cem\u003ePCP:3, PCC:4\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eHunan Children\u0026rsquo;s Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e5(\u003cem\u003ePCP:4, PCC:1\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eGuangzhou women and Children\u0026rsquo;s medical center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e5(\u003cem\u003ePCP:4, PCC:1\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnderlying disease, n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003ePrimary immunodeficiency disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eSolid tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eHematologic malignant disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eHSCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eSolid organ transplantation \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eRheumatic\u0026nbsp;disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eNephrotic syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eInherited\u0026nbsp;metabolic\u0026nbsp;disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eFever, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e52(88.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eMechanical ventilation, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e51(86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCo-infection, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e46(78.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 349px;\"\u003e\n \u003cp\u003eCytomegalovirus, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e21(35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContinued\u003c/strong\u003e \u003cstrong\u003eTable 1. General information of the patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eEpstein-Barr virus, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e6(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eAcinetobacter baumannii, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e5(8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eMycobacterium tuberculosis, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e4(6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eStreptococcus pneumoniae, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e4(6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eAnti-infection adjustment, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e26(44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePCP: pneumocystis jirovecii pneumonia; PCC: pneumocystis jirovecii colonisation; HSCT: \u0026nbsp;Hematopoietic stem cell transplantation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eComparison between the PCP group and the PCC group\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePCP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eZ/t/X\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNumber\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003en=51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003en=8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAge, months \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10.00(5.00, 48.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7.50(2.50, 31.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eWeight, kg \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8.50(6.75, 14.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7.50(5.50, 11.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMale, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e37(72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.870\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePELOD-2 zcore \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.32 \u0026plusmn; 2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.25 \u0026plusmn; 3.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.465\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHosipital stay time, days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e34.0(17.5, 48.5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e17.0(13.5, 23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.816\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePICU stay time, days \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e21.0(10.5, 37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e13.0(7.5, 16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMechanical ventilation \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003etime, days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16.00(7.00, 27.00) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.00(4.00, 11.50) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFever, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e46(90.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6(75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eWBC, 10\u003csup\u003e9\u003c/sup\u003e/L \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6.10(4.03, 10.20) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8.81(5.72, 11.51) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eLymphocyte, 10\u003csup\u003e9\u003c/sup\u003e/L \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.64(0.40, 2.20)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.14(1.96, 5.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.879\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCRP, mg/L \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e29.80(8.00, 83.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.99(0.50, 14.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.854\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eLDH, U/L \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e720(539, 978)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e372(279, 752)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.860\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCD3, 10\u003csup\u003e6\u003c/sup\u003e/ml \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e340(137, 1293)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1311(554, 2886)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.762\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCD8, 10\u003csup\u003e6\u003c/sup\u003e/ml \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e184(42, 549)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e530(210, 1273)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.762\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCD4, 10\u003csup\u003e6\u003c/sup\u003e/ml \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e79(28, 524)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e748(185, 1538)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eReads number（DNA）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5955(595, 23971)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8(3, 69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eBDG, pg/ml \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e292(161, 600)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e48(37, 138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eUnderlying disease, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePrimary immunodeficiency\u003c/p\u003e\n \u003cp\u003edisease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24(47.1) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSolid organ transplantation\u003c/p\u003e\n \u003cp\u003eor HSCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4(7.8) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSolid tumor \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e14(27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eGlucocorticoid,\u0026nbsp;n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e37(72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eContinued Table 2.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eComparison between the PCP group and the PCC group\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePCP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eZ/t/X\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNumber\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003en=51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003en=8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCo-infection, n(%) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e41(80.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eGround-glass opacity \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e26(51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCaspofungin, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e37(72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMortality, n(%) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e18(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.865\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean \u0026plusmn; SD, median (P\u003csub\u003e25\u003c/sub\u003e, P\u003csub\u003e75\u003c/sub\u003e) or number (%). PCP: pneumocystis jirovecii pneumonia; PCC: pneumocystis jirovecii colonisation; \u0026nbsp;PELOD-2: Pediatric logistic organ dysfunction score 2; PICU: Pediatric intensive care unit; WBC: White blood cell; CRP: C-reactive protein; LDH: \u0026nbsp;Lactic dehydrogenase; \u0026nbsp;BDG: 1,3-\u0026beta;-D-glucan; \u0026nbsp;HSCT: \u0026nbsp;Hematopoietic stem cell transplantation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eComparison of patients with different outcomes at discharge in PCP group\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eVariables \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eNon-survivors \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSurvivors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eZ/t/X\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eNumber\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eAge, months \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6.00(4.75, 21.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e20.00(5.50, 67.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eWeight, kilograms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e7.50(5.88, 9.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11.00(7.00, 16.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eMale, n(%)）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e12(66.7)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e25(75.8)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePELOD-2 score \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5.50 \u0026plusmn; 2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.59 \u0026plusmn; 2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eHosipital stay time, days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e20.5(9.5, 42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e38.0(22.5, 55.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePICU stay time, days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e16.0(8.5, 34.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e21.0(11.5, 40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eMechanical ventilation \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003etime, days \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13.00(6.00, 32.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19.00(8.00, 23.00) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eFever, n(%) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e17(94.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e29(87.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.794\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eWBC, 10\u003csup\u003e9\u003c/sup\u003e/L \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e7.40(4.87, 10.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5.40(3.28, 11.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.391\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eLymphocyte, \u0026nbsp; \u0026nbsp; \u0026nbsp;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.71(0.47, 1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.61(0.29, 3.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.730\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eCRP, mg/L \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e33.27(8.32, 83.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e28.00(5.32, 89.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eLDH, U/L \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e814(612, 1340)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e687(476, 916) \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eCD3, 10\u003csup\u003e6\u003c/sup\u003e/ml \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e126(51, 590)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e542(234, 1721)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.964\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eCD8, 10\u003csup\u003e6\u003c/sup\u003e/ml \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e60(6, 120)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e262(121, 635)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eCD4, 10\u003csup\u003e6\u003c/sup\u003e/ml \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e38(4, 65) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e268(64, 1015) \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eCD4 ratio \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e14.55(2.10, 32.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e27.91(15.10, 45.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eReads number（DNA）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4838(1285, 15329)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10359(371, 40994) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eBDG, pg/ml \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e185(151, 320)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e455(171, 675)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eUnderlying disease, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePrimary immunodeficiency\u003c/p\u003e\n \u003cp\u003edisease \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13(72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eSolid tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eSolid organ transplantation\u003c/p\u003e\n \u003cp\u003eor HSCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3(9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eGlucocorticoid,\u0026nbsp;n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13(72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e24(72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eContinued\u003c/strong\u003e \u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eComparison of patients with different outcomes at discharge in PCP group\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eVariables \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eNon-survivors \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSurvivors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eZ/t/X\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eNumber\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eCo-infection, n(%) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e14(77.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e27(81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eGround-glass opacity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10(35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e25(40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean \u0026plusmn; SD, median (P\u003csub\u003e25\u003c/sub\u003e, P\u003csub\u003e75\u003c/sub\u003e) or number (%). PCP: pneumocystis jirovecii pneumonia; PELOD-2: Pediatric logistic organ dysfunction score 2; PICU: Pediatric intensive care unit; WBC: White blood cell; CRP: C-reactive protein; LDH: \u0026nbsp;Lactic dehydrogenase; BDG: 1,3-\u0026beta;-D-glucan; \u0026nbsp;HSCT: Hematopoietic stem cell transplantation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Comparison of primary immunodeficiency and secondary immunodeficiency in PCP group\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eVariables \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eprimary \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eimmunodeficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSecondary immunodeficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eZ/t/X\u003csup\u003e2\u003c/sup\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eNumber\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eAge, months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6.00(4.00, 8.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e41.00(15.50, 67.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eWeight, kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7.00(5.90, 8.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e12.60(9.00, 16.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eMale, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e18(75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19(70.4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003ePELOD-2 score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.55 \u0026plusmn; 3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.12 \u0026plusmn; 2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.595\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eHosipital stay time, days \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e37.5(17.0, 48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e31.0(17.5, 51.0)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003ePICU stay time, days \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e21.0(11.5, 35.5 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e18.0(9.5, 39.0) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.985\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eMechanical ventilation\u003c/p\u003e\n \u003cp\u003etime, days \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19.0(9.0, 32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e14.0(6.0, 21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.445\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eFever, n(%) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e22(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e24(88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eWBC, 10\u003csup\u003e9\u003c/sup\u003e/L \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8.31(5.22, 12.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.60(3.03, 8.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eLymphocyte, \u0026nbsp; \u0026nbsp; \u0026nbsp;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.41(0.49, 2.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.59(0.28, 1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eIL-6, ng/L \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e25.2(8.2, 113.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e119.0(29.1, 276.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eCD3, 10\u003csup\u003e6\u003c/sup\u003e/ml \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e579(51, 1398) \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e274(179, 1293)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eCD8 \u0026nbsp; \u0026nbsp; \u0026nbsp;, 10\u003csup\u003e6\u003c/sup\u003e/ml\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e139(12, 551)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e191(96, 516)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.928\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eCD4 \u0026nbsp; \u0026nbsp; \u0026nbsp;, 10\u003csup\u003e6\u003c/sup\u003e/ml\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e175(12, 728)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e77(35, 524)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.885\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eCD4/CD8 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.70(1.00, 2.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.77(0.31, 1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eReads number（DNA）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8138(1642, 23591)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5431(590, 26679) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eBDG, pg/ml \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e224(164, 521)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e374(159, 619)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eMortality, n(%) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e13(54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5(18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean \u0026plusmn; SD, median (P\u003csub\u003e25\u003c/sub\u003e, P\u003csub\u003e75\u003c/sub\u003e) or number (%). PCP: pneumocystis jirovecii pneumonia; PELOD-2: Pediatric logistic organ dysfunction score 2; PICU: Pediatric intensive care unit; WBC: White blood cell; IL-6: Interleukin-6; BDG: 1,3-\u0026beta;-D-glucan;\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Metagenomic next-generation sequencing, Pneumocystis jirovecii pneumonia, Non-human immunodeficiency virus, Children","lastPublishedDoi":"10.21203/rs.3.rs-7061414/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7061414/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePneumocystis jirovecii (PJ) is a life-threatening opportunistic pathogen and an important cause of severe pneumonia in immunocompromised children. Accurate and timely diagnosis is the most important factor for improving pneumocystis jirovecii pneumonia (PCP) related mortality in individuals with non-human immunodeficiency virus (non-HIV) infection.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe retrospectively collected clinical data from critically ill children with PJ positive in the metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 59 non-HIV children were included in this study. We classified the children into the PCP group (n\u0026thinsp;=\u0026thinsp;51) and pneumocystis jirovecii colonization (PCC) group (n\u0026thinsp;=\u0026thinsp;8). When compared with the PCC group, the PCP group had lower lymphocyte numbers, higher C-reactive protein (CRP), a higher proportion of primary immunodeficiency disease, a higher imaging change of ground-glass opacity on CT scans and higher median mNGS reads number of PJ (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The optimal threshold value for discriminating pneumocystis jirovecii infection from colonization appeared to be 556 reads (sensitivity, 77.6%; specificity, 100.0%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe BALF mNGS may assist with differentiating between colonization and infection of pneumocystis jirovecii, which needs further investigation.\u003c/p\u003e","manuscriptTitle":"A retrospective, multicenter study on the pneumocystis jirovecii pneumonia in critically ill children with non-human immunodeficiency virus using metagenomics next-generation sequencing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 10:26:06","doi":"10.21203/rs.3.rs-7061414/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-08T08:58:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T08:23:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-02T16:16:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213342723353577305033775464324894154836","date":"2025-09-19T21:53:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265457557690585805747267373337984889665","date":"2025-09-19T09:02:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214349753401920124395698157958595296193","date":"2025-09-17T07:26:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-28T19:22:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"41125304806618837845134438080013487663","date":"2025-08-19T13:38:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145164614375842470989494979825805545445","date":"2025-08-19T10:58:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-13T09:34:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-03T02:01:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-30T17:24:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-30T12:29:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-07-30T12:26:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e41d229c-e0c7-4098-a7de-12aa3e3652f4","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T16:16:45+00:00","versionOfRecord":{"articleIdentity":"rs-7061414","link":"https://doi.org/10.1186/s12890-026-04163-9","journal":{"identity":"bmc-pulmonary-medicine","isVorOnly":false,"title":"BMC Pulmonary Medicine"},"publishedOn":"2026-02-07 15:59:43","publishedOnDateReadable":"February 7th, 2026"},"versionCreatedAt":"2025-08-21 10:26:06","video":"","vorDoi":"10.1186/s12890-026-04163-9","vorDoiUrl":"https://doi.org/10.1186/s12890-026-04163-9","workflowStages":[]},"version":"v1","identity":"rs-7061414","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7061414","identity":"rs-7061414","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}