Potential missed opportunities for diagnosis of cryptococcosis and the association with mortality: A cohort study.
Potential missed opportunities for diagnosis of cryptococcosis and the association with mortality: A cohort study.
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DOI：
10.1016/j.eclinm.2020.100563
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发表时间：
2020-10
影响因子：
15.1
通讯作者：
Spec A
中科院分区：
文献类型：
--
作者：
Salazar AS;Keller MR;Olsen MA;Nickel KB;George IA;Larson L;Powderly WG;Spec A
隐球菌病是全世界最常见的威胁生命的机会性真菌病之一。隐匿的表现和缓慢的症状出现使其难以识别，使诊断过程复杂化。延误诊断可能会导致死亡率增加。我们的目标是确定错失诊断隐球菌病机会的频率及其对死亡率的影响。为了估计住院患者中可能被漏诊的隐球菌病患者的比例，我们使用2005年至2015年期间8个州的医疗成本和利用项目状态住院数据库进行了一项回溯性队列研究。所有被诊断为隐球菌感染或隐球菌性脑膜炎的住院成人患者都包括在内。潜在漏诊被定义为在最初的隐球菌病入院前90天内，对暗示隐球菌病的程序或诊断进行编码的入院情况。使用广义估计方程模型来评估潜在的合并症和潜在的隐球菌病漏诊与90天全因住院死亡率之间的关联。在5354例隐球菌病患者中，2445例(45.7%)是艾滋病毒携带者(PLWH)。在PLWH中，493/2445(20.2%)存在潜在漏诊，其中83/493(16.8%)在住院期间死亡，而无潜在漏诊(相对危险度[RR]1·04，95%可信区间0·99-1·09)的患者中死亡265/1,952(13.6%)。在HIV阴性患者中，977/2909(33.6%)存在潜在漏诊，其中236/977(24.2%)在住院期间死亡，而未漏诊的298/1932(15.4%)(相对危险度1.12，95%可信区间1.07-1.16)。尽管诊断测试非常有效，但错失诊断隐球菌病的机会仍然很常见，而且与艾滋病毒阴性患者90天死亡率增加有关。高度的临床怀疑指数对于及时诊断、治疗和提高与隐球菌病相关的死亡率至关重要。国家高级翻译科学中心、华盛顿大学临床和翻译科学研究所以及医疗研究和质量机构。
Cryptococcosis is one of the most common life-threatening opportunistic mycoses worldwide. Insidious presentation and slow onset of symptoms make it difficult to recognize, complicating the diagnostic process. Delays in diagnosis may lead to increased mortality. We aim to determine the frequency of missed opportunities for diagnosis of cryptococcosis and its effects on mortality. To estimate the proportion of individuals with a potentially missed diagnosis for cryptococcosis in hospitalized patients, we conducted a retrospective cohort study using the Healthcare Cost and Utilization Project State Inpatient Databases from 2005 to 2015 from eight states. All hospitalized adult patients diagnosed with cryptococcal infection or cryptococcal meningitis were included. Potentially missed diagnoses were defined as admissions coded for a procedure or diagnosis suggestive of cryptococcosis in the 90-days prior to the initial cryptococcosis admission. Generalized estimating equations models were used to evaluate the association between underlying comorbidities and potential missed diagnosis of cryptococcosis and 90-day all-cause in-hospital mortality. Of 5,354 patients with cryptococcosis, 2,445 (45·7%) were people living with HIV (PLWH). Among PLWH, 493/2,445 (20·2%) had a potentially missed diagnosis, of which 83/493 (16·8%) died while hospitalized compared with 265/1,952 (13·6%) of those without a potentially missed diagnosis (relative risk [RR] 1·04, 95% CI 0·99–1·09). Among HIV-negative patients, 977/2,909 (33·6%) had a potentially missed diagnosis, of which 236/977 (24·2%) died while hospitalized compared with 298/1,932 (15·4%) of those not missed (RR 1·12, 95% CI 1·07–1·16). Missed opportunities to diagnose cryptococcosis are common despite highly efficacious diagnostic tests and are associated with increased risk of 90-day mortality in HIV-negative patients. A high index of clinical suspicion is paramount to promptly diagnose, treat, and improve cryptococcosis-related mortality. National Center for Advancing Translational Sciences, Washington University Institute of Clinical and Translational Sciences, and the Agency for Healthcare Research and Quality.
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DOI：
10.1097/qai.0000000000001899
发表时间：
2019-02-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Faini D;Kalinjuma AV;Katende A;Mbwaji G;Mnzava D;Nyuri A;Glass TR;Furrer H;Hatz C;Boulware DR;Letang E
通讯作者：
Letang E
影响因子：
3.7
作者：
Pyrgos V;Seitz AE;Steiner CA;Prevots DR;Williamson PR
通讯作者：
Williamson PR
影响因子：
11.8
作者：
Pappas, PG;Perfect, JR;Dismukes, WE
通讯作者：
Dismukes, WE
影响因子：
4.2
作者：
Cox, Helen S.;Daniels, Johnny F.;Hughes, Jennifer
通讯作者：
Hughes, Jennifer
影响因子：
5.9
作者：
Hevey, Matthew A.;George, Ige A.;Spec, Andrej
通讯作者：
Spec, Andrej