Abstract
BackgroundPulmonary cryptococcosis is an uncommon infectious disease that can develop in both immunocompromised and immunocompetent patients. Severity of chronic kidney disease (CKD) was reported to be one of the risk factors for pulmonary cryptococcosis, but its clinical characteristics have not been fully assessed. The purpose of this study is to clarify clinical characteristics of severe CKD in patients with pulmonary cryptococcosis.MethodsThe present study retrospectively investigated 56 patients who had pulmonary cryptococcosis with non-human immunodeficiency virus (HIV) infection and were treated at Saga University Hospital between 2005 and 2018. The clinical characteristics were evaluated and compared between patients with estimated glomerular filtration rate (eGFR) >45 mL/min/1.73m2 (n = 42) (preserved eGFR) and those with eGFR <45 mL/min/1.73m2 (n = 14) (declined eGFR).ResultsCompared with patients with preserved eGFR, those with declined eGFR had significantly higher rate of disseminated cryptococcosis (p = 0.03); higher percentage of patients who did not recover after treatment (p = 0.02); and more frequent clinical features of fever (p <0.01), pleural effusion (p = 0.03), high white blood cell count (p <0.01) and C-reactive protein (p <0.01), and low level of albumin (p <0.01). Multivariate analysis adjusted by immunosuppressive drug use indicated significant differences of fever (p <0.01), high white blood cell count (p = 0.03), C-reactive protein (p = 0.01) and low level of albumin (p <0.01) in patients with eGFR <45 mL/min/1.73m2.ConclusionSevere CKD is associated with poor clinical characteristics and outcomes in patients with non-HIV pulmonary cryptococcosis.
Clinical impact of severe chronic kidney disease in patients with non-HIV pulmonary cryptococcosis
