A retrospective study on prognostic factors of cryptococcal meningitis in 203 patients with acquired immunodeficiency syndrome

Abstract

Objective To explore the mortality and prognostic factors of cryptococcal meningitis (CM) in patients with acquired immunodeficiency syndrome (AIDS). Methods We collected the clinical data of all the 203 AIDS patients complicated with CM who had been treated between December 2010 and March 2017 in Chongqing Public Health Medical Center. They were followed up by telephone periodically after hospital discharge and their survival or death was recorded. Their overall mortality rate, survival curves and prognostic factors were then analyzed. Results Of the 203 cases included in this study, 92.6% had CD4+ T cell counts ≤100 cells/μL, 50.3% HIV RNA>5 lg copies/mL, and 64.5% intracranial pressure ≥250 mmH2O. Their mortality during hospital stay was 9.9% (20/203), mortality during follow-up 16.2% (24/148) and overall mortality 26.1%. Their survival rate declined rapidly during the first 2 weeks after disease onset, and their accumulated mortality was close to 25.0% at week 10 but stabilized thereafter. The patients aged between 18 and 44 years had a significantly lower risk of death than those of other age groups, showing that age was an independent protective prognostic factor (AOR=0.228, P=0.036, 95%CI: 0.057~0.910). Consciousness disorder was an independent risk factor for death (AOR=7.001, P=0.035, 95% CI: 1.143~42.882). Conclusions AIDS patients complicated with CM may face a high mortality and death may mostly occur within the first 3 months after disease onset. Those with a younger age may have relatively better prognosis. Consciousness disorder is a risk factor of death. Key words: Acquired immunodeficiency syndrome; Cryptococcal meningitis; Prognostic factors; Retrospective study