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[Meningeal cryptococcosis in patients living with HIV. Experience in intensive care]
Yésica Lamberto1, Pablo Saúl1, Rosana Gregori-Sabelli1
1Departamento de Terapia Intensiva-DAIPIC, Hospital de Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina.
Introduction:
Meningeal cryptococcosis (MC) is a frequent cause of meningoencephalitis in people living with HIV (PLHIV), leading to substantial morbidity (20-55%). Clinical characteristics, lethality and adverse prognostic factors in PLHIV with MC admitted to intensive care units (ICUs) are described.
Methods:
A retrospective observational study. Period from 11/21/2006 to 05/24/2023. It involved 154 adult PLHIV diagnosed with MC and admitted to ICUs. Percentages and absolute values were compared by Chi-Square or Fisher's test and medians by Mann-Whitney test. The association with mortality was assessed by logistic regression. SPSS 23.0 software was used. A p-value <0.05 was considered significant.
Results:
Patients who died and those who survived were comparable in age and sex (p>0.05). Univariate analysis showed that impaired functional and nutritional status, lack of previous highly active antiretroviral therapy, CD4 <100 cells, APACHE II ≥ 13 and a PLHIV prognostic score ≥ 8 points, requiring mechanical ventilation (MV), respiratory failure, renal failure, neurological dysfunction or sepsis could be associated (p<0.05) with mortality. Logistic regression established that impaired functional and nutritional status, a PLHIV prognostic score ≥ 8, need for MV and presence of sepsis would be independent variables associated with mortality.
Conclusion:
The results indicate that altered functional and nutritional status, a PLHIV prognostic score ≥ 8 points, requiring MV and suffering sepsis on admission to the ICU are more frequent in deceased patients, and they could therefore serve as independent variables to predict a higher risk of mortality.
Insights
Impaired functional/nutritional status, a high PLHIV prognostic score, need for mechanical ventilation, and sepsis are key predictors of mortality in people living with HIV (PLHIV) with meningeal cryptococcosis (MC) admitted to intensive care units (ICUs). These factors can help predict higher mortality risk.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- HIV/AIDS Research
Background:
- Meningeal cryptococcosis (MC) is a significant cause of meningoencephalitis in people living with HIV (PLHIV), associated with high morbidity (20-55%).
- Understanding clinical characteristics and prognostic factors in critically ill PLHIV with MC is crucial for improving outcomes.
Purpose of the Study:
- To describe clinical characteristics, lethality, and adverse prognostic factors for PLHIV with MC admitted to intensive care units (ICUs).
- To identify independent variables associated with mortality in this patient population.
Main Methods:
- Retrospective observational study of 154 adult PLHIV diagnosed with MC and admitted to ICUs between November 2006 and May 2023.
- Statistical analyses included Chi-Square/Fisher's test for categorical data, Mann-Whitney test for medians, and logistic regression to assess mortality association.
- A p-value <0.05 was considered statistically significant.
Main Results:
- Age and sex were comparable between survivors and non-survivors.
- Univariate analysis identified impaired functional/nutritional status, low CD4 count, high APACHE II score, high PLHIV prognostic score (≥8), need for mechanical ventilation (MV), respiratory/renal failure, neurological dysfunction, and sepsis as associated with mortality (p<0.05).
- Logistic regression revealed impaired functional/nutritional status, PLHIV prognostic score ≥8, need for MV, and sepsis as independent predictors of mortality.
Conclusions:
- Altered functional and nutritional status, a PLHIV prognostic score ≥ 8, need for MV, and sepsis upon ICU admission are more frequent in deceased patients.
- These factors can serve as independent variables to predict a higher risk of mortality in PLHIV with MC.
- The findings highlight critical indicators for risk stratification and management in ICUs.
