Cryptococcosis in patients with liver cirrhosis:Death risk factors and predictive value of prognostic models  

作　　者：Qi-Hui Zhou Cai-Qin Hu Yu Shi Feng-Tian Wu Qin Yang Jun Guan Ai-Chun Li Zhi Chen 

机构地区：[1]Department of Infectious Diseases,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,National Clinical Research Center for Infectious Diseases,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China

出　　处：《Hepatobiliary & Pancreatic Diseases International》2021年第5期460-468,共9页国际肝胆胰疾病杂志（英文版）

基　　金：supported by grants from the National Science and Technology Major Project of China(2018ZX10302206 and 2017ZX10202203)。

摘　　要：Background:Liver cirrhosis is associated with immune deficiency,which causes these patients to be susceptible to various infections,including cryptococcus infection.Mortality in cirrhotic patients with cryptococcosis has increased.The present study was to explore the risk factors of mortality and the predictive ability of different prognostic models.Methods:Forty-seven cirrhotic patients with cryptococcosis at a tertiary care hospital were included in this retrospective study.Data on demographics,clinical parameters,laboratory exams,diagnostic methods,medication during hospitalization,severity scores and prognosis were collected and analyzed.Student’s t test and Mann-Whitney test were used to compare characteristics of survivors and non-survivors at a 90-day follow-up and cerebrospinal fluid(CSF)manifestations of cryptococcal meningitis.Multivariate Cox regression analysis was used to identify the independent risk factors for mortality.Kaplan-Meier curves were used to analyze patient survival.Receiver operating characteristic(ROC)curves were used to evaluate the different prognostic factors.Results:The 30-and 90-day survival rates were 93.6%and 80.9%,respectively,in cirrhotic patients with cryptococcosis.Cryptogenic liver diseases[hazard ratio(HR)=7.567,95%confidence interval(CI):1.616-35.428,P=0.010],activated partial thromboplastin time(APTT)(HR=1.117,95%CI:1.016-1.229,P=0.022)and Child-Pugh score(HR=2.146,95%CI:1.314-3.504,P=0.002)were risk factors for 90-day mortality in cirrhotic patients with cryptococcosis.Platelet count(HR=0.965,95%CI:0.940-0.991,P=0.008)was a protective factor.APTT(HR=1.120,95%CI:1.044-1.202,P=0.002)and Child-Pugh score(HR=1.637,95%CI:1.086-2.469,P=0.019)were risk factors for 90-day mortality in cirrhotic patients with cryptococcal meningitis.There was significant difference in the percentage of lymphocytes in CSF between survivors and non-survivors[60.0(35.0-75.0)vs.95.0(83.8-97.2),P<0.001].The model of end-stage liver disease-sodium(MELD-Na)score was more accurate for predicting 30-d

关 键 词：CRYPTOCOCCOSIS CIRRHOSIS Risk factors PROGNOSIS 

分 类 号：R575.2[医药卫生—消化系统] R519.4[医药卫生—内科学]