End-Stage Liver Disease Is a Strong Predictor of Early Mortality in Cryptococcosis

Open Forum Infectious Diseases
Andrej SpecWilliam G Powderly

Abstract

Background.  Cryptococcosis in the setting of end-stage liver disease (ESLD) has been associated with high mortality. We sought to compare the outcome of cryptococcal disease in patients with ESLD to that of human immunodeficiency virus (HIV)-positive patients and to those patients without HIV or ESLD. Methods.  We assembled a retrospective cohort of 232 consecutive cases of cryptococcosis in our institution, from 2002 to 2014, inclusively. We analyzed the cases for comorbidities, type of infection, and survival. Data were analyzed with t tests, Fishers Exact test, and Kaplan-Meyer analysis. Results.  Twenty-five (10.8%) patients with cryptococcal infection had concomitant ESLD; of these, 5 (20%) presented with peritonitis. Most (17 of 25, 68%) did not have any other cause of immunocompromise that has been more classically associated with cryptococcosis. Patients with ESLD had a significantly higher mortality than HIV-positive patients and HIV-negative patients without ESLD (HIVNE) (80% vs 13.6% and 22.7%, respectively; P < .001). In addition, fatal outcome in ESLD patients occurred more rapidly than in HIVNE patients, with a median survival of 6 days (vs 17), despite a comparable time to diagnosis (6.2 vs 6.6 days). Conclusion...Continue Reading

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Citations

Oct 14, 2017·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Ige A GeorgeCarlos A Q Santos
Aug 14, 2019·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Matthew A HeveyAndrej Spec
Oct 9, 2019·Nature Communications·Donglei SunMeiqing Shi
Jun 4, 2020·Tropical Doctor·Venkat RameshSneha Varahala
Jun 12, 2020·Tropical Doctor·Venkat RameshGanta Saidulu
Nov 14, 2017·Current Clinical Microbiology Reports·Jane A O'HalloranAndrej Spec
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Feb 15, 2021·Transplant Infectious Disease : an Official Journal of the Transplantation Society·Ana Caroline Ferreira da SilvaTiago Sevá-Pereira
Jul 13, 2021·Open Forum Infectious Diseases·Jia-Hui ChengLi-Ping Zhu

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