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

Autor: Francelise Bridi Cavassin, Jose Ernesto Vidal, João Luiz Baú-Carneiro, Cássia Silva de Miranda Godoy, Renata de Bastos Ascenço Soares, Marcello Mihailenko Chaves Magri, Diego Rodrigues Falci, Carla Sakuma De Oliveira, Ana Verena Almeida Mendes, Giovanni Luís Breda, Caroline Martins Rego, Maíra Araujo Félix, Paula Pacheco Katopodis, Julia Raquel da Silva do Ó, Mirela Pereira Lima Abrão, Mariane Taborda, Talita Teles Teixeira Pereira, Flávio Queiroz-Telles
Rok vydání: 2023
Předmět:
Zdroj: Medical Mycology. 61
ISSN: 1460-2709
1369-3786
DOI: 10.1093/mmy/myad011
Popis: 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.
Databáze: OpenAIRE
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