Abstract
BackgroundDespite the profound impact of antiretroviral therapy in the control of AIDS mortality, central nervous system opportunistic infections remains a significant burden in AIDS patients. This retrospective study aims to elucidate the clinical characteristics, outcome and risk factors of cryptococcal meningitis (CM) poor prognosis in AIDS patients from a tertiary hospital in China.MethodsClinical data from 128 patients admitted in Beijing Ditan Hospital, Capital Medical University from November 2008 to November 2017 was collected. The cohort was stratified based on treatment outcome (effective 79%, and ineffective 21%), and Multivariate Logistic regression analysis used to identify risk factors of poor disease prognosis.ResultsAge, incidence of cerebral infarction, the proportion of consciousness disorder, and fasting plasma glucose was higher in the ineffective treatment group than the effective treatment group. The duration of treatment in the induction period of the ineffective group was significantly shorter than that of the effective group. Multivariate Logistic regression analysis indicated that the occurrence of cerebral hernia and consciousness disorder were risk factors for the prognosis of AIDS patients with CM infection, while the duration of treatment in the induction period was a indicative of a better prognosis in AIDS with CM infection complications. Finally, shunt decompression therapy correlated with a better disease outcome.ConclusionsThis retrospective study exposes the main risk factors associated with worse disease prognosis in AIDS patients with CM infection complications.
Highlights
Despite the profound impact of antiretroviral therapy in the control of Acquired Immunodeficiency Syndrome (AIDS) mortality, central nervous system opportunistic infections remains a significant burden in AIDS patients
We found that 9% mortality rate among AIDS patients with cryptococcal meningitis (CM) receiving anti-CM treatment, which is in agreement with previous literature reports worldwide
We found that occurrence of cerebral hernia and consciousness disorder are risk factors for the poor prognosis of AIDS patients with CM, which was consistent with conclusions reported in previous literature
Summary
Despite the profound impact of antiretroviral therapy in the control of AIDS mortality, central nervous system opportunistic infections remains a significant burden in AIDS patients. This retrospective study aims to elucidate the clinical characteristics, outcome and risk factors of cryptococcal meningitis (CM) poor prognosis in AIDS patients from a tertiary hospital in China. Cryptococcal meningitis (CM) is one of the most common causes of AIDS-related deaths in the world [2], and it is the most common fungal infection of the central nervous system, which is characterized by difficult treatment, high mortality and long course of disease. Initial intracranial pressure ≥ 250 mmH2O was found in 65% of CM patients, and consciousness disorder was an independent risk factor for death in CM patients [5]. Internal drainage is the key factor for better prognosis, and cerebrospinal fluid (CSF) positive for cryptococcus before surgery is not a contraindication [3]
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