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Relevance of intracranial hypertension control in the management of Cryptococcus neoformans meningitis related to AIDS

  • Clinical and Epidemiological Study
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Abstract

Purpose

To evaluate the relationship between intracranial hyperpressure (HICP) and mortality in patients with cryptococcal meningitis related to AIDS (CMRA).

Methods

This was an observational retrospective study. Patients were treated according to the Infectious Diseases Society of America recommendations during the evaluation period (days 0, 3, 5 and after hospitalization). High intracranial pressure (HICP) was defined as ICP values of ≥250 mm H20. The correlation between HICP and mortality at each of the three time points considered was investigated. Statistical analysis on the descriptive parameters and on the probability of a “death” event (odds ratio, OR) at each of those three time points was performed using the statistical software program Epidata.

Results

Eighty patients were included in this study, of whom 53 (66.25 %) were male. The average age of the patients was 37.5 ± 8.1 (range 22–55) years. The median CD4+ lymphocyte cell count was 35 (range 0–367) cells/ml. Among the entire patient cohort, 53 patients had a favorable outcome, and the mortality rate was 33.75 %. At baseline (day 0), 57 subjects (71.5 %) presented HICP, and these patients had a higher mortality rate than those with a normal ICP, but the difference did not reach statistical significance [OR 1.65, 95 % confidence interval (CI) 0.56–4.84]. On day 3, 41 of the patients presented HICP, and HICP at this time point was significantly associated with an increased risk of mortality (OR 4.35, 95 % CI 1.56–12.09). On day 5, 35 (43.5 %) patients presented HICP, and HCIP at this time point was also significantly associated with higher mortality (OR 7.23, 95 % CI 2.53–20.14).

Conclusion

The results of this study confirm an association between HICP and mortality in patients with CMRA and indicate that the control of ICP during the first 5 days of hospitalization is more important than managing HICP only at baseline.

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Conflict of interest

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Authors and Affiliations

  1. Special Assistance Division, Intensive Care Department, Hospital Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires, Argentina

    L. de Vedia, M. I. Calderón, A. Rodríguez, N. Lista, E. Di Virgilio, J. C. Cisneros & R. Prieto

  2. Mycology Unit, Hospital Dr. Francisco J. Muñiz, Buenos Aires, Argentina

    A. Arechavala & E. Maiolo

Authors
  1. L. de Vedia
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  2. A. Arechavala
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  3. M. I. Calderón
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  4. E. Maiolo
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  5. A. Rodríguez
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  6. N. Lista
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  7. E. Di Virgilio
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  8. J. C. Cisneros
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  9. R. Prieto
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Correspondence to L. de Vedia.

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de Vedia, L., Arechavala, A., Calderón, M.I. et al. Relevance of intracranial hypertension control in the management of Cryptococcus neoformans meningitis related to AIDS. Infection 41, 1073–1077 (2013). https://doi.org/10.1007/s15010-013-0538-4

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  • DOI: https://doi.org/10.1007/s15010-013-0538-4

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