Division of Infectious Diseases, Department of Internal Medicine, North Mississippi Medical Center, Tupelo, MS, USA.
Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA.
Mycoses. 2021 Sep;64(9):1073-1082. doi: 10.1111/myc.13323. Epub 2021 Jun 10.
Cryptococcosis is classically associated with the immunocompromised patients but there is a rising appreciation for its impact on the immunocompetent hosts. We sought to analyse the trends, diagnosis, treatment of different hosts and the effect of immunodeficiency and chronic liver disease on relapse and in-house mortality.
This is a retrospective study of 12 years of patients with cryptococcosis, divided into three different groups: HIV-infected, transplant and non-HIV non-transplant (NHNT). Data were analysed with Chi-square, unpaired parametric t test, simple and multivariate logistic regression analysis.
Of 114 identified patients, 23 (20.2%) had HIV infection, 11 (9.6%) had transplant, 80 (70.2%) were NHNT patients. Overall, mortality was 28.1% (32/114) and relapse occurred in 10.5% (12/114) of patients. The mortality trend was higher (OR = 2.346, p = .287) in the transplant group (45.5%, 5/11) than in HIV (26.1%, 6/23) and NHNT groups (26.3%, 21/80). HIV was associated with relapse; 30.4% (7/23) for HIV-positive patients and 5.5% (5/91) for HIV-negative patients (OR = 7.525, p = .002). Chronic liver disease had a large and statistically significant association with mortality on multivariate analysis (OR = 3.583, p = .013) which was more pronounced than the HIV or transplant groups. It was independently associated with mortality by chi-square analysis (OR 3.137, p = .012).
Chronic liver disease represented 30.7% (35/114) of all studied patients. It was a risk factor for in-hospital mortality. HIV infection and transplant were not statistically significant for mortality. Relapse was highest in the HIV-infected patients at 30.4% (7/23). These data highlight the effect of type and degree of immunocompromise on cryptococcosis.
cryptococcosis 经典地与免疫功能低下的患者相关，但人们对其在免疫功能正常宿主中的影响的认识正在提高。我们旨在分析不同宿主的趋势、诊断、治疗以及免疫缺陷和慢性肝病对复发和院内死亡率的影响。
这是一项对 12 年 cryptococcosis 患者的回顾性研究，分为三组：HIV 感染、移植和非 HIV 非移植（NHNT）。采用卡方检验、非配对参数 t 检验、简单和多变量逻辑回归分析进行数据分析。
在确定的 114 名患者中，23 名（20.2%）有 HIV 感染，11 名（9.6%）有移植，80 名（70.2%）为 NHNT 患者。总体而言，死亡率为 28.1%（32/114），10.5%（12/114）的患者复发。移植组（45.5%，5/11）的死亡率趋势高于 HIV（26.1%，6/23）和 NHNT 组（26.3%，21/80）（OR=2.346，p=0.287）。HIV 与复发相关；HIV 阳性患者为 30.4%（7/23），HIV 阴性患者为 5.5%（5/91）（OR=7.525，p=0.002）。多变量分析显示，慢性肝病与死亡率有很大的统计学关联（OR=3.583，p=0.013），比 HIV 或移植组更为显著。卡方分析表明，它与死亡率独立相关（OR 3.137，p=0.012）。
慢性肝病占所有研究患者的 30.7%（35/114）。它是院内死亡的一个危险因素。HIV 感染和移植对死亡率没有统计学意义。复发率在 HIV 感染患者中最高，为 30.4%（7/23）。这些数据突出了免疫抑制的类型和程度对 cryptococcosis 的影响。
