Table 5.
Univariate and Multivariate Analysis of Factors Associated With 1-Year Mortality in Patients With Cirrhosis and Cryptococcal Meningitis (n = 38)
| Univariate Analysis | Multivariate Analysis | |||||
|---|---|---|---|---|---|---|
| Factor | Survived (n = 29) | Died (n = 9) | OR (95% CI) | P Value | HR (95% CI) | P Value |
| Age >65 y | 4 (13.9) | 5 (55.6) | 7.813 (1.073–57.660) | .010 | 1.623 (.394–6.691) | .503 |
| Male sex | 20 (69.0) | 4 (44.4) | 0.360 (.058–2.178) | .146 | 0.665 (.146–3.026) | .598 |
| Time to diagnosis >120 d | 1 (3.4) | 2 (22.2) | 8.000 (.342–488.179) | .134 | 18.619 (2.117–163.745) | .008 |
| Child-Pugh classification | ||||||
| A | 10 (34.5) | 1 (11.1) | 0.238 (.005–2.303) | .237 | … | |
| B | 14 (48.3) | 2 (22.2) | 0.306 (.027–2.051) | .254 | … | |
| C | 5 (17.2) | 6 (66.7) | 9.600 (1.366–75.089) | .009 | 7.555 (1.393–40.971) | .019 |
| Etiology of cirrhosis | ||||||
| HBV infection | 17 (58.6) | 6 (66.7) | 1.412 (.238–10.380) | 1.000 | … | |
| Autoimmune liver disease | 6 (20.7) | 3 (33.3) | 1.917 (.236–12.617) | .655 | … | |
| Concurrent predisposing factors | 17 (58.6) | 6 (66.7) | 1.412 (.238–10.380) | 1.000 | … | |
| Autoimmune disease | 5 (17.2) | 3 (33.3) | 2.400 (.283–16.713) | .363 | … | |
| Glucocorticoid or immunosuppressant therapy | 6 (20.7) | 2 (22.2) | 1.095 (.089–8.215) | 1.000 | … | |
| Baseline symptoms | ||||||
| Fever | 27 (93.1) | 8 (88.9) | 0.593 (.028–39.280) | 1.000 | … | |
| Mild fever (37.2°C–38°C) | 6 (20.7) | 2 (22.2) | 1.095 (.089–8.215) | 1.000 | … | |
| Moderate fever (38.1°C–39°C) | 16 (55.2) | 3 (33.3) | 0.406 (.056–2.417) | .447 | … | |
| Severe fever (>39°C) | 5 (17.2) | 3 (33.3) | 2.400 (.283–16.713) | .363 | … | |
| GCS score <15 | 8 (27.6) | 5 (55.6) | 3.281 (.532–20.618) | .226 | … | |
| Epilepsy | 2 (6.9) | 1 (11.1) | 1.688 (.025–35.994) | 1.000 | … | |
| Vomiting | 8 (27.6) | 5 (55.6) | 3.281 (.532–20.618) | .226 | … | |
| Baseline cranial imaging abnormalitya | 22 (84.6) | 5 (62.5) | 0.303 (.038–2.843) | .315 | … | |
| Meningeal enhancement | 7 (41.2) | 0 (0.0) | … | .509 | … | |
| Multiple parenchyma damage | 16 (61.5) | 4 (50.0) | 0.625 (.094–4.244) | .689 | … | |
| Ventricular enlargement | 4 (15.4) | 3 (37.5) | 3.300 (.352–26.610) | .315 | … | |
| Baseline laboratory testsb | ||||||
| Opening pressure of lumbar puncture >300 mm H2O | 7 (41.2) | 2 (33.3) | 0.714 (.052–6.870) | 1.000 | … | |
| CSF culture | 18 (78.3) | 4 (66.7) | 0.556 (.058–8.006) | .612 | … | |
| CSF ink smear | 17(63.0) | 5 (71.4) | 1.471 (.190–17.997) | 1.000 | … | |
| CSF protein >1000 mg/L | 16 (59.3) | 5 (71.4) | 1.719 (.223–20.837) | .682 | … | |
| CSF glucose <1.1 mmol/L | 5 (18.5) | 2 (33.3) | 2.200 (.153–20.860) | .584 | … | |
| Serum CrAg titer >1:1280 | 5 (29.4) | 2 (33.3) | 1.200 (.082–12.082) | 1.000 | … | |
| CSF CrAg titer >1:1280 | 6 (37.5) | 3 (50.0) | 1.667 (.162–16.602) | .655 | … | |
| Initial therapyc | ||||||
| AmB ± FC | 6 (20.7) | 1 (16.7) | 0.767 (.139–9.176) | 1.000 | … | |
| AmB + FCZ ± FC | 4 (13.8) | 1 (16.7) | 1.250 (.021–16.900) | 1.000 | … | |
| FCZ ± FC | 12 (41.4) | 0 (0.0) | … | .074 | … | 1.000 |
Data are presented as No. (%) unless otherwise indicated.
Abbreviations: AmB, amphotericin B; CI, confidence interval; CrAg, cryptococcal antigen; CSF, cerebrospinal fluid; FC, flucytosine; FCZ, fluconazole; GCS, Glasgow Coma Scale; HBV, hepatitis B virus; HR, hazard ratio; OR, odds ratio.
aCranial imaging was performed in 34 patients, while 19 of them underwent enhanced cranial magnetic resonance imaging or computed tomography.
bOpening pressure of lumbar puncture was recorded in 23 patients. CSF culture, ink smear, protein, glucose, and CrAg titer were available in 29, 34, 34, 33, and 23 patients, respectively. Quantitative CrAg test performed in serum was documented in 22 patients.
cA total of 35 patients were included, as the other 3 patients died acutely within 1 week after diagnosis.