Prediction of Hospital Discharge Outcome From Changes in Albumin Quotient and Cerebrospinal Fluid Lactate Dehydrogenase in Patients With Cryptococcal Meningitis

Abstract

BackgroundCryptococcal meningitis (CM) is a life-threatening infection of the central nervous system that occurs in healthy individuals and immunocompromised patients, and reliable prognostic parameters are needed urgently. This study analyzed the clinical characteristics and laboratory findings of CM patients from two tertiary care hospitals in China between 2015 and 2019, aiming to provide reliable prognostic factors for patients with CM.MethodsClinical characteristics and laboratory findings of CM patients were retrospectively reviewed. The unfavorable outcome was defined as no improvement or worsening symptoms and signs or persistent positive results for CSF culture or death after starting treatment. The significant differences in clinical characteristics and symptoms between the patients with favorable and unfavorable outcomes were descriptively analyzed. For comparison of mean values of laboratory results between the patients with favorable and unfavorable outcomes, the t test was performed.Results63 patients with CM were enrolled in this study and 67% were men. 38/63 patients were confirmed to be HIV serology positive. The mean onset age of all patients was 49±15 (20– 77) years. For clinical characteristics, headache, nausea and/or vomiting, and fever were the most common symptoms. Older age and disturbance of consciousness tended to poor prognosis. Changes in serum antioxidant parameters were significantly associated with clinical outcome. For CSF parameters, there were significant correlations between changes in leukocyte count, lactate dehydrogenase and chloride, and outcomes in different groups. For HIV-infected patients, increased CD4+ T cell counts suggested good prognosis. Increased CSF/serum albumin quotient (Qalb) was indicative of unfavorable outcome in HIV-negative patients.ConclusionsIn summary, CSF lactate dehydrogenase and albumin quotient may improve prediction of outcome in patients with CM. We recommend incorporation of Qalb value analysis and pay attention to change of CSF LDH during hospitalization.