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Clinical features and Outcomes of Cryptococcemia patients with and without HIV infection
Author(s) -
Zhao Handan,
Zhou Minghan,
Zheng Qing,
Zhu Mingjian,
Yang Zongxing,
Hu Caiqin,
Xu Lijun
Publication year - 2021
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.13261
Subject(s) - medicine , odds ratio , hypoalbuminemia , confidence interval , amphotericin b , gastroenterology , cryptococcus , retrospective cohort study , human immunodeficiency virus (hiv) , cryptococcal meningitis , surgery , immunology , antifungal , viral disease , dermatology , microbiology and biotechnology , biology
Background The effects of cryptococcemia on patient outcomes in those with or without HIV remain unclear. Methods One hundred and seventy‐nine cryptococcemia patients were enrolled in this retrospective study. Demographic characteristics, blood test results and outcome were compared between the two groups. Results The diagnosis time of Cryptococcus infection was 2.0(0‐6.0) days for HIV‐infected patients, 5.0 (1.5‐8.0) days for HIV‐uninfected patients ( p = .008), 2.0 (1.0‐6.0) days for cryptococcal meningitis (CM) patients and 6.0 (5.0‐8.0) days for non‐CM patients ( p < .001). HIV infection [adjusted odds ratio (AOR) (95% confidence interval): 6.0(2.3‐15.9)], CRP < 15 mg/L [AOR:3.7(1.7‐8.1)) and haemoglobin > 110 g/L [AOR:2.5(1.2‐5.4)] were risk factors for CM development. Forty‐six (25.7%) patients died within 90 days. ICU stay [AOR:2.8(1.1‐7.1)], hypoalbuminemia [AOR:2.7(1.4‐5.3)], no anti‐cryptococcal treatment [AOR:4.7(1.9‐11.7)] and altered consciousness [AOR:2.4(1.0‐5.5)] were independent risk factors for 90‐day mortality in all patients. HIV infection did not increase the 90‐day mortality of cryptococcemia patients when anti‐ Cryptococcus treatment was available. Non‐Amphotericin B treatment [AOR:3.4(1.0‐11.2)] was associated with 90‐day mortality in HIV‐infected patients, but age ≥ 50.0 years old [AOR:2.7(1.0‐2.9)], predisposing disease [AOR:4.1(1.2‐14.2)] and altered consciousness [AOR:3.7(1.1‐12.9)] were associated with 90‐day mortality in HIV‐uninfected patients who accepted anti‐ Cryptococcus treatment. Conclusion HIV infection increased the incidence of CM rather than mortality in cryptococcemia patients. The predictive model was completely divergent in HIV‐infected and HIV‐uninfected patients, suggesting that novel strategies for diagnosis and treatment algorithms are urgently needed.