Characteristics, mortality, associated variables with death, and therapeutic response among HIV-positive, solid organ transplant (SOT), and non-HIV-positive/non-transplant (NHNT) patients with cryptococcosis: First multicenter cohort study in Brazil.
Francelise Bridi CavassinJosé Ernesto VidalJoão Luiz Baú-CarneiroCássia Silva de Miranda GodoyRenata de Bastos Ascenço SoaresMarcello Mihailenko Chaves MagriDiego Rodrigues FalciCarla Sakuma De OliveiraAna Verena Almeida MendesGiovanni Luís BredaCaroline Martins RegoMaíra Araujo FélixPaula Pacheco KatopodisJulia Raquel da Silva do ÓMirela Pereira Lima AbrãoMariane TabordaTalita Teles Teixeira PereiraFlávio Queiroz-TellesPublished in: Medical mycology (2023)
Cryptococcosis is traditionally associated with immunocompromised patients but is increasingly being identified in those without the human immunodeficiency virus (HIV) or other immunocompetent individuals. We aim to describe the characteristics, mortality, and associated variables with death among hospitalized patients with cryptococcosis in Brazil. This is the first multicenter retrospective cohort study conducted in seven public tertiary Brazilian hospitals. A total of 384 patients were included; the median age was 39 years and 283 (73.7%) were men. In all, 304 HIV-positive were hosts (79.2%), 16 (4.2%) solid organ transplant (SOT), and 64 (16.7%) non-HIV-positive/non-transplant (NHNT). Central nervous system (CNS) cryptococcosis had a significantly higher number across disease categories, with 313 cases (81.5%). A total of 271 (70.6%) patients were discharged and 113 (29.4%) died during hospitalization. In-hospital mortality among HIV-positive, SOT, and NHNT was 30.3% (92/304), 12.5% (2/16), and 29.7% (19/64), respectively. Induction therapy with conventional amphotericin B (AMB) mainly in combination with fluconazole (234; 84.2%) was the most used. Only 80 (22.3%) patients received an AMB lipid formulation: liposomal (n = 35) and lipid complex (n = 45). Most patients who died belong to the CNS cryptococcosis category (83/113; 73.4%) when compared with the others (P = .017). Multivariate analysis showed that age and disseminated cryptococcosis had a higher risk of death (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05; P = .008 and OR, 1.84; 95% CI, 1.01-3.53; P = .048, respectively). Understanding the epidemiology of cryptococcosis in our settings will help to recognize the burden and causes of mortality and identify strategies to improve this scenario.
Keyphrases
- hiv positive
- antiretroviral therapy
- men who have sex with men
- human immunodeficiency virus
- south africa
- end stage renal disease
- hiv infected
- ejection fraction
- newly diagnosed
- chronic kidney disease
- hiv testing
- prognostic factors
- peritoneal dialysis
- clinical trial
- hiv aids
- cardiovascular events
- type diabetes
- intensive care unit
- healthcare
- mental health
- acute respiratory distress syndrome
- cross sectional
- fatty acid
- candida albicans
- smoking cessation
- mechanical ventilation