Table 2.
Characteristics of the patients with and without central nervous system cryptococcal disease
| CNS disease |
||||
|---|---|---|---|---|
| Characteristic | Yes (n=80) | No (n=49) | OR (95% CI) | P-value |
| Age, median (IQR), year | 54 (43–60) | 54 (47–60) | … | 0.45 |
| Gender, Male | 59/79 (75) | 32/46 (70) | 1.29 (0.58–2.89) | 0.54 |
| Type of transplant | … | 0.092 | ||
| Liver | 17 (21) | 13 (27) | ||
| Lung | 4 (5) | 6 (12) | ||
| Kidney | 44 (55) | 19 (39) | ||
| Heart | 4 (5) | 7 (14) | ||
| Pancreas | 7 (9) | 4 (8) | ||
| Combined | 4 (5) | 0 (0) | ||
| Primary immunosuppressive agents | ||||
| Calcineurin inhibitors | 67 (84) | 47 (96) | 0.22 (0.047–1.02) | 0.053 |
| Tacrolimus | 55 (69) | 40 (82) | 0.50 (0.21–1.17) | 0.11 |
| Cyclosporine A | 12 (15) | 7 (14) | 1.06 (0.39–2.90) | 0.91 |
| Non-calcineurin inhibitor-based regimen1 | 13 (16) | 2 (4) | 4.56 (0.98–21.2) | 0.053 |
| T-cell antibody agent use2 | 5/79 (6) | 2 (4) | 1.59 (0.30–8.52) | 0.71 |
| Prednisone | 77 (96) | 39 (80) | 6.58 (1.71–25.3) | 0.002 |
| Median (IQR), mg | 10 (5–10) | 7 (4–10) | … | 0.026 |
| Dose ≥10 mg/day | 46/71 (65) | 18/45 (40) | 2.76 (1.28–5.96) | 0.009 |
| Rejection | 18/79 (23) | 12 (25) | 0.91 (0.39–2.10) | 0.82 |
| Retransplantation | 9 (11) | 7 (14) | 0.76 (0.26–2.2) | 0.61 |
| Renal dysfunction (creatinine ≥2.0 mg/dl) | 25/63 (40) | 10/44 (23) | 2.23 (0.94–5.32) | 0.066 |
| CMV infection | 16/78 (21) | 12/48 (25) | 0.77 (0.33–1.82) | 0.56 |
| CMV disease | 7/76 (9.2) | 8/46 (17) | 0.48 (0.16–1.43) | 0.18 |
| Time to onset of cryptococcosis | ||||
| Median (IQR), month | 25 (9.2–67) | 17 (8.7–26) | … | 0.051 |
| >12 months | 55 (69) | 31 (63) | 1.28 (0.60–2.70) | 0.52 |
| >24 months | 40 (50) | 17 (35) | 1.88 (0.90–3.92) | 0.089 |
| Symptoms | ||||
| Fever | 43/79 (54) | 14/45 (31) | 2.96 (1.38–6.38) | 0.005 |
| Abnormal mental status | 37/79 (47) | 2/48 (4.2) | 20.3 (4.60–89.3) | <0.001 |
| Site involved other than CNS | ||||
| Pulmonary | 33 (41) | 38 (78) | 0.20 (0.091–0.45) | <0.001 |
| Cutaneous | 15 (19) | 8 (16) | 1.18 (0.46–3.04) | 0.73 |
| Serum cryptococcal antigen | ||||
| Positive antigen | 53/55 (96) | 27/43 (63) | 15.7 (3.36–73.3) | <0.001 |
| Titer | ||||
| Median (IQR) | 512 (32–1024) | 8 (0–64) | … | <0.001 |
| >1:64 | 36/55 (66) | 8/43 (19) | 8.29 (3.21–21.4) | <0.001 |
| Fungemia | 29/76 (38) | 2/46 (4.3) | 13.6 (3.06–60.3) | <0.001 |
CNS, central nervous system; OR, odds ratio; CI, confidence interval; IQR, interquartile range. Data are No. (%) of patients, unless otherwise indicated. Denominators are shown when missing data exist.
1
Patients with CNS disease: these patients received azathioprine (9), mycophenolate mofetil (2), mycophenolate mofetil and rapamycin (1), and prednisone (1) without a calcineurin-inhibitor agent. Patients without CNS disease: these patients received mycophenolate mofetil (1), mycophenolate mofetil and rapamycin (1) without a calcineurin-inhibitor agent.
2
Use within 6 months of onset of cryptococcosis.