https://scholars.lib.ntu.edu.tw/handle/123456789/528968
標題: | Cryptococcaemia: Clinical features and prognostic factors | 作者: | Jean S.-S. CHI-TAI FANG Shau W.-Y. YEE-CHUN CHEN SHAN-CHWEN CHANG PO-REN HSUEH CHIEN-CHING HUNG KWEN-TAY LUH |
公開日期: | 2002 | 卷: | 95 | 期: | 8 | 起(迄)頁: | 511-518 | 來源出版物: | QJM - Monthly Journal of the Association of Physicians | 摘要: | Background: Limited data are available on the clinical significance of cryptococcaemia, which occurs in 10-30% of patients with cryptococcal diseases. Aim: To describe the clinical features of cryptococcaemia and identify its prognostic factors. Study design: Retrospective cohort study. Methods: All adult patients with Cryptococcus neoformans isolated from blood culture at the National Taiwan University Hospital, Taipei, 1981-2001, were included. Demographic and clinical information was obtained from medical records. Results: Fifty-two patients were diagnosed and treated for cryptococcaemia. Acquired immunodeficiency syndrome (24/52, 46%), immunosuppressive therapy (12/52, 23%) and decompensated liver cirrhosis (11/52, 21%) were the three major predisposing conditions. Forty-two patients (81%, n = 52) had sepsis, including four patients with septic shock, when blood cultures were obtained. Of the 38 patients in whom lumbar puncture was done, cerebrospinal fluid culture showed meningeal involvement in 32 (84%). The 30-day fatality rate was 37%. Liver cirrhosis, septic shock at presentation, an initial APACHE II score ? 20, age ? 60 years and female gender were associated with mortality under univariate analysis. Starting antifungal therapy within 48 h after blood culture was associated with improved survival. Under multivariate analysis, liver cirrhosis remained a strong independent predictor of mortality at 30 days after blood culture (HR 16.3, 95%Cl 2.6-101.7, P = 0.003). Discussion: Patients with cryptococcaemia have a high risk of mortality within 30 days. Sepsis and meningeal involvement are common. Those with liver cirrhosis have a particularly poor prognosis. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/528968 | ISSN: | 1460-2725 | DOI: | 10.1093/qjmed/95.8.511 | SDG/關鍵字: | amphotericin B; antifungal agent; corticosteroid; cytotoxic agent; fluconazole; flucytosine; immunosuppressive agent; acquired immune deficiency syndrome; adolescent; adult; age; article; blood culture; cerebrospinal fluid culture; clinical feature; cohort analysis; controlled study; cryptococcosis; Cryptococcus neoformans; demography; fatality; female; fungus isolation; gender; hematologic disease; high risk patient; human; immunosuppressive treatment; liver cirrhosis; lumbar puncture; major clinical study; male; medical information; medical record; meningitis; mortality; mycosis; prediction; priority journal; prognosis; retrospective study; scoring system; sepsis; septic shock; statistical analysis; survival rate; Taiwan; university hospital |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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