Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China.
BMC Infect Dis. 2020 Jan 22;20(1):69. doi: 10.1186/s12879-020-4794-5.
Cryptococcal meningitis (CM) is the most common fungal infection of the central nervous system and has high morbidity and mortality. Almost studies about prognostic factors have largely focused on the immunocompromised population rather than immunocompetent patients. So that we sought to conduct a retrospective study to determine prognostic factors which predict the outcomes in immunocompetent patients with CM.
We retrospectively collected and analyzed the demographic and clinical data of 76 apparently immunocompetent patients with cryptococcal meningitis from January 2003 to June 2019 in China. The clinical outcome was graded by the Glasgow outcome scale (GOS) at discharge, and patients were divided into good (score of 5) and unfavorable (score of 1-4) outcome groups, potential prognostic factors were analyzed.
Non-parametric test confirmed that unfavorable outcome was associated with lower glucose level of CSF(P = 0.001), and Pearson's χ2 analysis confirmed that unfavorable outcome was associated with opening pressure of CSF(>300mmH20, P = 0.038), impaired consciousness (P = 0.001), hydrocephalus(P = 0.045), and Shunt surgery (P = 0.045), and then multiple logistic regression analysis confirmed that impaired consciousness(P = 0.015) and lower glucose concentration of CSF(P = 0.012) increased the likelihood of unfavorable outcome in CM patients.
Impaired consciousness and decreased glucose concentration of CSF were independently prognostic factors which predict the unsatisfactory outcome in immunocompetent patients with CM.
隐球菌性脑膜炎（CM）是最常见的中枢神经系统真菌感染，具有高发病率和死亡率。几乎所有关于预后因素的研究都主要集中在免疫功能低下的人群，而不是免疫功能正常的患者。因此，我们试图进行一项回顾性研究，以确定预测免疫功能正常的 CM 患者结局的预后因素。
我们回顾性收集并分析了 2003 年 1 月至 2019 年 6 月在中国的 76 例明显免疫功能正常的隐球菌性脑膜炎患者的人口统计学和临床数据。根据出院时的格拉斯哥结局量表（GOS）对临床结局进行评分，将患者分为预后良好（评分 5）和预后不良（评分 1-4）两组，分析潜在的预后因素。
非参数检验证实，预后不良与脑脊液葡萄糖水平较低有关（P=0.001），Pearson χ2 分析证实，预后不良与脑脊液压力升高（>300mmH20，P=0.038）、意识障碍（P=0.001）、脑积水（P=0.045）和分流手术（P=0.045）有关，然后多因素逻辑回归分析证实意识障碍（P=0.015）和脑脊液葡萄糖浓度降低（P=0.012）增加了 CM 患者预后不良的可能性。
意识障碍和脑脊液葡萄糖浓度降低是预测免疫功能正常的 CM 患者预后不良的独立预后因素。
