Predictors of mortality and differences in clinical features among patients with Cryptococcosis according to immune status.
Predictors of mortality and differences in clinical features among patients with Cryptococcosis according to immune status.
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DOI：
10.1371/journal.pone.0060431
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Pappas PG
中科院分区：
文献类型：
--
作者：
Brizendine KD;Baddley JW;Pappas PG
隐球菌病是一种侵袭性真菌感染，造成大量的发病率和死亡率。预后因素主要来自现代抗真菌和强效抗逆转录病毒联合治疗、免疫抑制和移植之前进行的试验。需要描述现代队列中的临床特征和死亡率预测因素的数据。我们对1996年至2010年在我们机构诊断为隐球菌病的患者进行了一项回顾性队列研究。数据包括人口统计学、临床特征、诊断、治疗和结局。我们确定了302例患者：108例（36%）人类免疫缺陷病毒（HIV）阳性，84例（28%）器官移植受者（OTR），110例（36%）非HIV，非移植（NHNT）患者，包括39例无可识别的免疫缺陷。平均年龄为49岁，203例（67%）为男性，170例（56%）为白色。90天时的全因死亡率为21%。在多变量logistic回归分析中，（OR 5.09，95%CI 2.54-10.22）且基线打开压力>25 cmH 2 O（OR 2.93，95% CI 1.25-6.88）与死亡率增加相关;与NHNT患者相比，HIV阳性患者（OR 0.46，95% CI 0.19-1.16）和OTR（OR 0.46，95% CI 0.21-1.05）的死亡几率较低。现代隐球菌病死亡率的预测因素包括隐球菌血症、高颅内压和NHNT状态，而用于诱导的药物和历史预后因素（包括器官衰竭综合征和恶性血液病）与死亡率无关。
Cryptococcosis is an invasive fungal infection causing substantial morbidity and mortality. Prognostic factors are largely derived from trials conducted prior to the modern era of antifungal and potent combination antiretroviral therapies, immunosuppression, and transplantation. Data describing the clinical features and predictors of mortality in a modern cohort are needed. We conducted a retrospective cohort study of patients at our institution diagnosed with cryptococcosis from 1996 through 2010. Data included demographics, clinical features, diagnostics, treatment, and outcomes. We identified 302 individuals: 108 (36%) human immunodeficiency virus (HIV)-positive, 84 (28%) organ transplant recipients (OTRs), and 110 (36%) non-HIV, non-transplant (NHNT) patients including 39 with no identifiable immunodeficiency. Mean age was 49 years, 203 (67%) were male and 170 (56%) were white. All-cause mortality at 90 days was 21%. In multivariable logistic regression analyses, cryptococcemia (OR 5.09, 95% CI 2.54–10.22) and baseline opening pressure >25 cmH2O (OR 2.93, 95% CI 1.25–6.88) were associated with increased odds of mortality; HIV-positive patients (OR 0.46, 95% CI 0.19–1.16) and OTRs (OR 0.46, 95% CI 0.21–1.05) had lower odds of death compared to NHNT patients. Predictors of mortality from cryptococcosis in the modern period include cryptococcemia, high intracranial pressure, and NHNT status while drug(s) used for induction and historical prognostic factors including organ failure syndromes and hematologic malignancy were not associated with mortality.
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影响因子：
3.7
作者：
Chau TT;Mai NH;Phu NH;Nghia HD;Chuong LV;Sinh DX;Duong VA;Diep PT;Campbell JI;Baker S;Hien TT;Lalloo DG;Farrar JJ;Day JN
通讯作者：
Day JN
影响因子：
3.7
作者：
Dromer F;Bernede-Bauduin C;Guillemot D;Lortholary O;French Cryptococcosis Study Group
通讯作者：
French Cryptococcosis Study Group
影响因子：
11.8
作者：
Pappas, PG;Perfect, JR;Dismukes, WE
通讯作者：
Dismukes, WE
影响因子：
3.8
作者：
Park, Benjamin J.;Wannemuehler, Kathleen A.;Chiller, Tom A.
通讯作者：
Chiller, Tom A.
影响因子：
9.6
作者：
Aberg, JA;Mundy, LM;Powderly, WG
通讯作者：
Powderly, WG