Tsai Yu-Chi, Chen Yao-Shen, Yao Cai-Sin, Chang Ren-In, Wang Ning-Chi, Chen Jui-Kuang
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Open Forum Infect Dis. 2024 Sep 20;11(10):ofae540. doi: 10.1093/ofid/ofae540. eCollection 2024 Oct.
Cryptococcal meningitis (CM) is a severe central nervous system infection. In patients with HIV infections and coexisting CM, elevated baseline cerebrospinal fluid (CSF) lactate levels can predict increased mortality. However, the CSF lactate level's significance in patients with CM who are HIV negative remains unclear, necessitating further investigation to elucidate the potential distinctions and enhance patient management. This study investigated the significance of CSF lactate levels in patients with CM who were HIV negative.
This retrospective study utilized data from the clinical databases of patients who underwent lumbar punctures at a medical center in Kaohsiung City, southern Taiwan. Demographic data, CSF lactate levels, routine CSF analyses, and hematologic and neurologic findings were evaluated. The optimal CSF lactate threshold value was determined by the Youden index.
This retrospective study included 70 patients with CM, among whom 44 (63%) and 26 (37%) tested negative and positive for HIV, respectively. The group without HIV exhibited higher CSF lactate levels, with an optimal CSF lactate cutoff point of 7.935 mmol/L for predicting 90-day mortality, resulting in significant predictive accuracies (area under the curve, 0.755; sensitivity, 57.1%; specificity, 100%); this value was an independent mortality predictor in patients who were HIV negative. In patients with CM who were HIV negative, CSF lactate levels ≥7.935 mmol/L correlated with higher mortality rates but without statistical significance. All patients with CM who were HIV negative and had CSF lactate levels ≥7.935 mmol/L died within 3 months of admission.
Patients with CM who were HIV negative had elevated CSF lactate levels that correlated with adverse outcomes, enabling early identification of high-risk individuals.
隐球菌性脑膜炎（CM）是一种严重的中枢神经系统感染。在合并CM的HIV感染患者中，基线脑脊液（CSF）乳酸水平升高可预测死亡率增加。然而，CSF乳酸水平在HIV阴性的CM患者中的意义尚不清楚，需要进一步研究以阐明潜在差异并加强患者管理。本研究调查了HIV阴性的CM患者中CSF乳酸水平的意义。
这项回顾性研究利用了台湾南部高雄市一家医疗中心接受腰椎穿刺患者的临床数据库数据。评估了人口统计学数据、CSF乳酸水平、CSF常规分析以及血液学和神经学检查结果。通过约登指数确定最佳CSF乳酸阈值。
这项回顾性研究纳入了70例CM患者，其中44例（63%）HIV检测为阴性，26例（37%）HIV检测为阳性。无HIV感染组的CSF乳酸水平较高，预测90天死亡率的最佳CSF乳酸截断点为7.935 mmol/L，具有显著的预测准确性（曲线下面积，0.755；敏感性，57.1%；特异性，100%）；该值是HIV阴性患者死亡率的独立预测指标。在HIV阴性的CM患者中，CSF乳酸水平≥7.935 mmol/L与较高死亡率相关，但无统计学意义。所有HIV阴性且CSF乳酸水平≥7.935 mmol/L的CM患者在入院后3个月内死亡。
HIV阴性的CM患者CSF乳酸水平升高，与不良预后相关，有助于早期识别高危个体。
