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Risk factors for mortality from primary cryptococcosis in patients with HIV

Mohammad M Sajadi1, Kristina M Roddy, Kirk M Chan-Tack

  • 1Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA. msajadi@ihv.umaryland.edu

Postgraduate Medicine
|April 1, 2009
PubMed

Insights

Mortality from cryptococcosis remains high in HIV-positive patients. Predictors of death include syncope, pneumonia, respiratory failure, and ICU admission, not amphotericin dose or opening pressure.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • HIV/AIDS Research

Background:

  • Cryptococcosis poses a significant mortality risk for human immunodeficiency virus (HIV)-positive individuals.
  • Despite advancements in antifungal treatments, intracranial pressure management, and antiretroviral therapy, mortality rates remain high.

Purpose of the Study:

  • To identify predictors of inpatient mortality among HIV-positive patients diagnosed with cryptococcosis.
  • To analyze factors associated with increased risk of death within 30 days of diagnosis.

Main Methods:

  • Retrospective chart review of inpatient cases at two medical centers (1993-2004).
  • Data collection included demographics, symptoms, CD4 counts, lumbar puncture results (opening pressure, cryptococcal antigen levels), infection sites, and therapies.
  • Multivariate and survival analyses were employed to assess mortality predictors.

Main Results:

  • A total of 202 HIV-positive patients with primary cryptococcosis were identified.
  • Common infection sites included the central nervous system (85%), blood (72%), and lower respiratory tract (34%).
  • Overall 30-day mortality was 14%. Independent predictors of mortality included syncope, concomitant pneumonia, respiratory failure, and intensive care unit admission.

Conclusions:

  • Mortality associated with cryptococcosis in HIV-positive patients remains a critical concern.
  • Specific clinical indicators like syncope, respiratory failure, pneumonia, and ICU admission are strongly linked to increased 30-day mortality risk.
  • Opening pressure and amphotericin dose did not emerge as significant predictors of mortality in this cohort.

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