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Baseline Serum C-Reactive Protein Level Predicts Mortality in Cryptococcal Meningitis
Supavit Chesdachai1, Nicole W Engen2, Joshua Rhein1
1Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Open Forum Infectious Diseases
|December 18, 2020
Summary
Higher baseline C-reactive protein (CRP) levels are linked to increased mortality in HIV-positive individuals with cryptococcal meningitis. CRP may indicate coinfections or immune issues, worsening outcomes.
Area of Science:
- Infectious Diseases
- Immunology
- Clinical Medicine
Background:
- C-reactive protein (CRP) is an acute phase protein indicating systemic inflammation.
- CRP serves as a biomarker for infection progression and resolution.
- Its role in cryptococcal meningitis outcomes requires further investigation.
Purpose of the Study:
- To determine the association between baseline CRP levels and cryptococcal meningitis outcomes in HIV-infected individuals.
- To assess the correlation of temporal CRP changes with patient survival.
Main Methods:
- A prospective study of 168 HIV-infected Ugandans with first-episode cryptococcal meningitis.
- Baseline plasma CRP levels were measured within 5 days of diagnosis and categorized into quartiles.
- Time-to-event analysis was used to compare baseline CRP with 18-week survival.
Main Results:
- Higher baseline CRP levels (>49.5 mg/L) were associated with significantly increased 18-week mortality rates (55%).
- The lowest CRP quartile (<29.0 mg/L) showed a markedly lower mortality rate (14%).
- Adjusted analysis confirmed CRP's significant association with mortality (aHR, 1.084 per 10 mg/L; P=.0016).
Conclusions:
- Elevated baseline CRP is a significant predictor of increased mortality in HIV-associated cryptococcal meningitis.
- CRP may serve as a surrogate marker for occult coinfections or immune dysregulation.
- These findings highlight CRP's potential utility in risk stratification for advanced AIDS patients with cryptococcal meningitis.
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