The clinical characteristics and outcome of cryptococcal meningitis with AIDS in a tertiary hospital in China: an observational cohort study

Wu, Liang; Xiao, Jing; Song, Yangzi; Gao, Guiju; Zhao, Hongxin

doi:10.1186/s12879-020-05661-9

Cited by 14 publications

(20 citation statements)

References 18 publications

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“…Impaired consciousness and stiff neck are common clinical manifestations and symptoms in patients with CM, and their incidence was significantly higher in patients with unfavorable outcomes [ 25 ]. Wu et al reported that the presence of impaired consciousness increased the risk of poor prognosis by a factor of 4.4 [ 24 ]. High urea nitrogen level is often a manifestation of abnormal renal function.…”

Section: Discussionmentioning

confidence: 99%

Establishment of a novel scoring model for mortality risk prediction in HIV-infected patients with cryptococcal meningitis

Zhao

Nie

et al. 2021

BMC Infect Dis

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Background Cryptococcal meningitis (CM) remains a leading cause of death in HIV-infected patients, despite advances in CM diagnostic and therapeutic strategies. This study was performed with the aim to develop and validate a novel scoring model to predict mortality risk in HIV-infected patients with CM (HIV/CM). Methods Data on HIV/CM inpatients were obtained from a Multicenter Cohort study in China. Independent risk factors associated with mortality were identified based on data from 2013 to 2017, and a novel scoring model for mortality risk prediction was established. The bootstrapping statistical method was used for internal validation. External validation was performed using data from 2018 to 2020. Results We found that six predictors, including age, stiff neck, impaired consciousness, intracranial pressure, CD4+ T-cell count, and urea levels, were associated with poor prognosis in HIV/CM patients. The novel scoring model could effectively identify HIV/CM patients at high risk of death on admission (area under curve 0.876; p<0.001). When the cut-off value of 5.5 points or more was applied, the sensitivity and specificity was 74.1 and 83.8%, respectively. Our scoring model showed a good discriminatory ability, with an area under the curve of 0.879 for internal validation via bootstrapping, and an area under the curve of 0.886 for external validation. Conclusions Our developed scoring model of six variables is simple, convenient, and accurate for screening high-risk patients with HIV/CM, which may be a useful tool for physicians to assess prognosis in HIV/CM inpatients.

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Section: Discussionmentioning

confidence: 99%

Establishment of a novel scoring model for mortality risk prediction in HIV-infected patients with cryptococcal meningitis

Zhao

Nie

et al. 2021

BMC Infect Dis

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“…Compared to several previous studies which have also identi ed some similar risk factors associated with poor prognosis in CM patients [9,[21][22][23][24][25], the present study differs in the following aspects: 1) All of our study participants were HIV-infected persons while the study participants in the majority of previous studies were HIV-negative persons, and the total number of participants in this study was 555, which is a relatively large sample size with regards to these types of studies. 2) Some studies chose neurocognitive impairment, seizures, neurological sequelae, relapse, or treatment effectiveness as outcome indicators in their analysis of risk factors for HIV/CM, rather than death as an outcome.…”

Section: Discussionmentioning

confidence: 77%

“…Impaired consciousness and stiff neck are common clinical manifestations and symptoms in patients with CM, and their incidence was signi cantly higher in patients with unfavorable outcomes [25]. Wu et al reported that the presence of impaired consciousness increased the risk of poor prognosis by a factor of 4.4 [24]. High urea nitrogen level is often a manifestation of abnormal renal function.…”

Section: Discussionmentioning

confidence: 99%

Establishment of a novel scoring model for mortality risk prediction in HIV-infected patients with cryptococcal meningitis

Zhao

Nie

et al. 2021

Preprint

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Purpose: Cryptococcal meningitis (CM) remains a leading cause of death in HIV-infected patients, despite advances in CM diagnostic and therapeutic strategies. This study was performed with the aim to develop and validate a novel scoring model to predict mortality risk in HIV-infected patients with CM (HIV/CM).Methods: Data on HIV/CM inpatients were obtained from a Multicenter Cohort study in China. Independent risk factors associated with mortality were identified based on data from 2013 to 2017, and a novel scoring model for mortality risk prediction was established. The prediction probability of the novel model was evaluated and verified using data from 2018 to 2020.Results: We found that six predictors, including age, stiff neck, impaired consciousness, intracranial pressure, CD4+ T-cell count, and urea levels, were associated with poor prognosis in HIV/CM patients. The novel scoring model could effectively identify HIV/CM patients at high risk of death on admission (area under curve 0.876; p＜0.001). When the cut-off value of 5.5 points or more was applied, the sensitivity and specificity was 74.1% and 83.8%, respectively. Additionally, our scoring model showed a good discriminatory ability in the validation cohort (area under curve 0·886; p＜0.001).Conclusions: Our developed scoring model of six variables is simple, convenient, and accurate for screening high-risk patients with HIV/CM, which may be a useful tool for physicians to assess prognosis in HIV/CM inpatients.

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“…Біохімічне дослідження ліквору виявило підвищення вмісту білку -0,6 (0,3-1,0) г/л, а також зниження концентрації глюкози -2,3 (1,4-2,9) ммоль/л. Зазначені зміни є харак-терними для даного захворювання і не відрізняються від даних інших досліджень [9,14,15,16 На наступному етапі аналізу ми порівняли вихідні дані хворих, які померли (група 1), а також тих, стан яких покращився і вони були виписані з відділення (група 2).…”

Section: рис 2 розподіл вихідного характеру ліквору за плеоцитозомunclassified

Clinical-laboratory features and prognostic factors of adverse clinical outcome in patients with cryptococcal meningoencephalitis and HIV infection

Zhyvytsia

Myroshnychenko

2021

Modern Medical Technology

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One of the major tasks in the fight against the HIV epidemic in Ukraine was to provide effective care to the most severe patients with HIV-infection (PLHIV) and cryptococcal meningoencephalitis (CM). The study of clinical characteristics and predictors of adverse clinical outcomes may provide a key to improving treatment outcomes in critically ill patients. Purpose of the study. The aim of our study was to determine the clinical and laboratory features and prognostic factors of adverse clinical outcome in patients with cryptococcal meningoencephalitis and HIV infection. Material and methods. We conducted a retrospective study that included 71 adult patients with HIV-infectionand CM. Atthefirststage, astudy of socio-demographic, clinical, clinical-laboratory, immunological and virological indicators of patients from the general group was conducted. In the second stage, patients were divided into two groups. Group 1 included 26 PLHIV with fatalities. Group 2 included 45 HIV-infected patients who were discharged after completion of inpatient treatment. The baseline of the standard clinical and laboratory examination between the two groups was compared and the factors of development of adverse clinical outcome in patients with CM on the background of HIV infection were identified. Results and discussion. The clinical characteristics of the average HIV-infected patient with CM admitted to the inpatient department are as follows: these are young patients (average 38 years, 79% from 23 to 44), HIV was diagnosed within 10 months before the onset of the disease, with normal body mass index, predominantly sexually rout of transmission HIV (83%), who mostly had no experience of ART (87%) or took ART for 1 month (1,1 (0,33–1,93) months). These patients did not have significant gender differences (men – 53%, women – 47%), had severe immunosuppression (number of CD4 lymphocytes 23,0 (9,0–56,0) cells per μl) and high levels of viral HIV load (5,6 (4,8–6,2) log10 IU/ml). Cerebrospinal fluid examination revealed a weak level of pleocytosis (10,0 (4,0–38,0) cells per μl), which was mostly normal (27–38%) or lymphocytic (26–37%), as well as a decrease in glucose 2,3 (1,4–2,9) mmol/l and increase in protein level – 0,6 (0,3–1,0) g/l. In group 1 the share of men was significantly lower (p = 0,015) than in group 2 – 9 (34,6%) against 29 (64,4%). The level of urea in plasma, at normal values, in the group of dead patients was higher (P = 0,047) than in the group with a favorable result. In the group of fatal cases, a higher proportion of patients had disorders of consciousness (P = 0,027), dysarthria (P = 0,021) and cognitive impairment (P = 0,021). In group 2, a higher proportion of patients had initial complaints of nausea and/or vomiting (P = 0,027). Conclusions. Clinical and laboratory features of a patient with CM and HIV infection in Ukraine are young age, normal body mass index, sexual route of infection, lack of experience in ART, severe immunosuppression and high levels of HIV viral load. In patients with CM and HIV infection, cerebrospinal fluid examination revealed mild pleocytosis (10,0 (4,0–38,0) cells per μl), which was predominantly normal (27–38%) or lymphocytic (26–37%), decrease in glucose levels of 2,3 (1,4–2,9) mmol/l and an increase in protein levels – 0,6 (0,3–1,0) g/l. Predictors of the development of adverse clinical outcomes in patients with CM and HIV infection are females, as well as the presence of hospitalization of disorders of consciousness, dysarthria and cognitive impairment.

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The clinical characteristics and outcome of cryptococcal meningitis with AIDS in a tertiary hospital in China: an observational cohort study

Cited by 14 publications

References 18 publications

Establishment of a novel scoring model for mortality risk prediction in HIV-infected patients with cryptococcal meningitis

Establishment of a novel scoring model for mortality risk prediction in HIV-infected patients with cryptococcal meningitis

Establishment of a novel scoring model for mortality risk prediction in HIV-infected patients with cryptococcal meningitis

Clinical-laboratory features and prognostic factors of adverse clinical outcome in patients with cryptococcal meningoencephalitis and HIV infection

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