PMID- 23555970
OWN - NLM
STAT- MEDLINE
DCOM- 20130924
LR  - 20220408
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 8
IP  - 3
DP  - 2013
TI  - Predictors of mortality and differences in clinical features among patients with 
      Cryptococcosis according to immune status.
PG  - e60431
LID - 10.1371/journal.pone.0060431 [doi]
LID - e60431
AB  - INTRODUCTION: Cryptococcosis is an invasive fungal infection causing substantial 
      morbidity and mortality. Prognostic factors are largely derived from trials 
      conducted prior to the modern era of antifungal and potent combination 
      antiretroviral therapies, immunosuppression, and transplantation. Data describing 
      the clinical features and predictors of mortality in a modern cohort are needed. 
      METHODS: We conducted a retrospective cohort study of patients at our institution 
      diagnosed with cryptococcosis from 1996 through 2010. Data included demographics, 
      clinical features, diagnostics, treatment, and outcomes. RESULTS: We identified 
      302 individuals: 108 (36%) human immunodeficiency virus (HIV)-positive, 84 (28%) 
      organ transplant recipients (OTRs), and 110 (36%) non-HIV, non-transplant (NHNT) 
      patients including 39 with no identifiable immunodeficiency. Mean age was 49 
      years, 203 (67%) were male and 170 (56%) were white. All-cause mortality at 90 
      days was 21%. In multivariable logistic regression analyses, cryptococcemia (OR 
      5.09, 95% CI 2.54-10.22) and baseline opening pressure >25 cmH2O (OR 2.93, 95% CI 
      1.25-6.88) were associated with increased odds of mortality; HIV-positive 
      patients (OR 0.46, 95% CI 0.19-1.16) and OTRs (OR 0.46, 95% CI 0.21-1.05) had 
      lower odds of death compared to NHNT patients. CONCLUSIONS: Predictors of 
      mortality from cryptococcosis in the modern period include cryptococcemia, high 
      intracranial pressure, and NHNT status while drug(s) used for induction and 
      historical prognostic factors including organ failure syndromes and hematologic 
      malignancy were not associated with mortality.
FAU - Brizendine, Kyle D
AU  - Brizendine KD
AD  - Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio, United 
      States of America. brizenk@ccf.org
FAU - Baddley, John W
AU  - Baddley JW
FAU - Pappas, Peter G
AU  - Pappas PG
LA  - eng
GR  - T32AI520699/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20130326
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Antifungal Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Antifungal Agents/therapeutic use
MH  - Cryptococcosis/complications/*diagnosis/drug therapy/*mortality
MH  - Cryptococcus neoformans/*isolation & purification
MH  - Female
MH  - HIV/isolation & purification
MH  - HIV Infections/complications
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Retrospective Studies
MH  - Transplants
MH  - Treatment Outcome
PMC - PMC3608592
COIS- Competing Interests: The authors have the following interests: JWB reports that 
      he is an advisor for Merck, a consultant for Abbott and Pfizer, and a Pfizer 
      research grant recipient. PGP reports that he has received research support from 
      and has been an ad hoc advisor for Merck, Pfizer, Astellas, Schering-Plough, 
      Basilea, and Novartis. This does not alter the authors' adherence to all the PLOS 
      ONE policies on sharing data and materials.
EDAT- 2013/04/05 06:00
MHDA- 2013/09/26 06:00
PMCR- 2013/03/26
CRDT- 2013/04/05 06:00
PHST- 2012/10/29 00:00 [received]
PHST- 2013/02/27 00:00 [accepted]
PHST- 2013/04/05 06:00 [entrez]
PHST- 2013/04/05 06:00 [pubmed]
PHST- 2013/09/26 06:00 [medline]
PHST- 2013/03/26 00:00 [pmc-release]
AID - PONE-D-12-33865 [pii]
AID - 10.1371/journal.pone.0060431 [doi]
PST - ppublish
SO  - PLoS One. 2013;8(3):e60431. doi: 10.1371/journal.pone.0060431. Epub 2013 Mar 26.