Prediction of hospital discharge outcome from changes in cerebrospinal fluid/serum albumin quotient and cerebrospinal fluid lactate dehydrogenase in patients with cryptococcal meningitis

2021 ◽  
Author(s):  
Yue Huang ◽  
Jun Zou ◽  
Ke-ming Zhang ◽  
Hang Li ◽  
Dong-ying Hu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Prognostic Factors ◽  
Lactate Dehydrogenase ◽  
Serum Albumin ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Leukocyte Count ◽  
Laboratory Findings ◽  
Csf Lactate ◽  
Hiv Negative

Aim: This study aims to provide reliable prognostic factors for patients with cryptococcal meningitis (CM). Patients & methods: Clinical characteristics and laboratory findings of CM patients were retrospectively reviewed. Results: Sixty-three patients with CM were enrolled and 38/63 were confirmed to be HIV serology positive. Among clinical characteristics, headache, nausea and/or vomiting, and fever were the most common symptoms. Among cerebrospinal fluid (CSF) parameters, changes in leukocyte count, lactate dehydrogenase and chloride were significantly associated with the outcome. An increased CSF/serum albumin quotient (QAlb) was indicative of an unfavorable outcome in HIV-negative patients. Conclusion: CSF lactate dehydrogenase and QAlb may improve the prediction of outcomes in patients with CM.

scholarly journals Prediction of Hospital Discharge Outcome From Changes in Albumin Quotient and Cerebrospinal Fluid Lactate Dehydrogenase in Patients With Cryptococcal Meningitis

2021 ◽  
Author(s):  
Yue Huang ◽  
Jun Zou ◽  
Ke-ming Zhang ◽  
Hang Li ◽  
Dong-ying Hu ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Unfavorable Outcome ◽  
Laboratory Findings ◽  
Value Analysis ◽  
Mean Values ◽  
Cell Counts ◽  
Disturbance Of Consciousness

Abstract BackgroundCryptococcal meningitis (CM) is a life-threatening infection of the central nervous system that occurs in healthy individuals and immunocompromised patients, and reliable prognostic parameters are needed urgently. This study analyzed the clinical characteristics and laboratory findings of CM patients from two tertiary care hospitals in China between 2015 and 2019, aiming to provide reliable prognostic factors for patients with CM.MethodsClinical characteristics and laboratory findings of CM patients were retrospectively reviewed. The unfavorable outcome was defined as no improvement or worsening symptoms and signs or persistent positive results for CSF culture or death after starting treatment. The significant differences in clinical characteristics and symptoms between the patients with favorable and unfavorable outcomes were descriptively analyzed. For comparison of mean values of laboratory results between the patients with favorable and unfavorable outcomes, the t test was performed.Results63 patients with CM were enrolled in this study and 67% were men. 38/63 patients were confirmed to be HIV serology positive. The mean onset age of all patients was 49±15 (20– 77) years. For clinical characteristics, headache, nausea and/or vomiting, and fever were the most common symptoms. Older age and disturbance of consciousness tended to poor prognosis. Changes in serum antioxidant parameters were significantly associated with clinical outcome. For CSF parameters, there were significant correlations between changes in leukocyte count, lactate dehydrogenase and chloride, and outcomes in different groups. For HIV-infected patients, increased CD4+ T cell counts suggested good prognosis. Increased CSF/serum albumin quotient (Qalb) was indicative of unfavorable outcome in HIV-negative patients.ConclusionsIn summary, CSF lactate dehydrogenase and albumin quotient may improve prediction of outcome in patients with CM. We recommend incorporation of Qalb value analysis and pay attention to change of CSF LDH during hospitalization.

scholarly journals Cerebrospinal Fluid Lactate as a Prognostic Marker of Disease Severity and Mortality in Cryptococcal Meningitis

2020 ◽  
Author(s):  
Mahsa Abassi ◽  
Ananta S Bangdiwala ◽  
Edwin Nuwagira ◽  
Kiiza Kandole Tadeo ◽  
Michael Okirwoth ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Disease Severity ◽  
Prognostic Marker ◽  
Mental Status ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Point Of Care ◽  
Altered Mental Status ◽  
Csf Lactate ◽  
Lactate Levels

Abstract Background Cerebrospinal fluid (CSF) lactate levels can differentiate between bacterial and viral meningitis. We measured CSF lactate in individuals with cryptococcal meningitis to determine its clinical significance. Methods We measured point-of-care CSF lactate at the bedside of 319 HIV-infected Ugandan adults at diagnosis of cryptococcal meningitis. We summarized demographic variables and clinical characteristics by CSF lactate tertiles. We evaluated the association of CSF lactate with clinical characteristics and survival. Results Individuals with high CSF lactate >5 mmol/L at cryptococcal diagnosis more likely presented with altered mental status (p<.0001), seizures (p=.0005), elevated intracranial opening pressure (p=.03), higher CSF white cells (p=.007), and lower CSF glucose (p=.0003) compared to those with mid-range (3.1 to 5 mmol/L) or low (≤3 mmol/L) CSF lactate levels. Two-week mortality was higher among individuals with high baseline CSF lactate >5 mmol/L (35%; 38/109) as compared to individuals with mid-range (22%; 25/112) or low CSF lactate (9%; 9/97; p=<.0001). After multivariate adjustment, CSF lactate >5mmol/L remained independently associated with excess mortality (adjusted Hazard Ratio = 3.41; 95%CI, 1.55-7.51; p=.002). We found no correlation between baseline CSF lactate levels and blood capillary lactate levels (p=.72). Conclusions Baseline point-of-care CSF lactate levels may be utilized as a prognostic marker of disease severity and mortality in cryptococcal meningitis. Individuals with an elevated baseline CSF lactate are more likely to present with altered mental status, seizures, elevated CSF opening pressures, and are at a greater risk of death. Future studies are needed to determine targeted therapeutic management strategy in persons with high CSF lactate.

scholarly journals Cerebrospinal Fluid Lactate as a Prognostic Marker of Disease Severity and Mortality in Cryptococcal Meningitis

2020 ◽  
Author(s):  
Mahsa Abassi ◽  
Ananta S Bangdiwala ◽  
Edwin Nuwagira ◽  
Kiiza Kandole Tadeo ◽  
Michael Okirwoth ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Disease Severity ◽  
Prognostic Marker ◽  
Mental Status ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Point Of Care ◽  
Altered Mental Status ◽  
Csf Lactate ◽  
Lactate Levels

Background: Cerebrospinal fluid (CSF) lactate levels can differentiate between bacterial and viral meningitis. We measured CSF lactate in individuals with cryptococcal meningitis to determine its clinical significance. Methods: We measured point-of-care CSF lactate at the bedside of 319 HIV-infected Ugandan adults at diagnosis of cryptococcal meningitis. We summarized demographic variables and clinical characteristics by CSF lactate tertiles. We evaluated the association of CSF lactate with clinical characteristics and survival. Results: Individuals with high CSF lactate >5 mmol/L at cryptococcal diagnosis more likely presented with altered mental status (p<.0001), seizures (p=.0005), elevated intracranial opening pressure (p=.03), higher CSF white cells (p=0.007), and lower CSF glucose (p=.0003) compared to those with mid-range (3.1 to 5 mmol/L) or low (≤3 mmol/L) CSF lactate levels. Two-week mortality was higher among individuals with high baseline CSF lactate >5 mmol/L (35%; 38/109) as compared to individuals with mid-range (22%; 25/112) or low CSF lactate (9%; 9/97; p=<.0001). After multivariate adjustment, CSF lactate >5mmol/L remained independently associated with excess mortality (adjusted Hazard Ratio = 3.41; 95%CI, 1.55-7.51; p=.002). We found no correlation between baseline CSF lactate levels and blood capillary lactate levels (p=.72). Conclusions: Baseline point-of-care CSF lactate levels may be utilized as a prognostic marker of disease severity and mortality in cryptococcal meningitis. Individuals with an elevated baseline CSF lactate are more likely to present with altered mental status, seizures, elevated CSF opening pressures, and are at a greater risk of death. Future studies are needed to determine targeted therapeutic management strategy in persons with high CSF lactate.

scholarly journals Cryptococcal meningitis in young adults: clinical characteristics and therapeutic outcomes

2019 ◽  
Author(s):  
Che-Wei Hsu ◽  
Chia-Yi Lien ◽  
Jun-Jun Lee ◽  
Wen-Neng Chang ◽  
Wan-Chen Tsai
Keyword(s):  
Young Adults ◽  
Prognostic Factors ◽  
Young Adult ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Laboratory Data ◽  
Adult Group ◽  
Laboratory Findings ◽  
Therapeutic Outcomes

Abstract Background: The clinical characteristics of cryptococcal meningitis (CM) in young adults (≤ 40 years old) have not been reported. The purpose of this study was to delineate the clinical characteristics, laboratory findings and therapeutic outcomes of young adults with CM, and compare them with older adults (> 40 years old) with CM. Methods: Ninety-nine adult patients with CM (64 men, 35 women) were enrolled from 2002-2016, of whom 26 were ≤ 40 years old (young adult group) and 73 were > 40 years old (non-young adult group). The clinical characteristics, laboratory data and therapeutic outcomes of these two groups were compared. The prognostic factors of the young adult CM patients were analyzed, and the clinical characteristics and laboratory data between the young adult CM patients with and without acquired immune-compromised syndrome (AIDS) were compared. The modified Rankin scale (mRS) was used to evaluate the outcomes of the survivors at the time of discharge and at 1 year of follow-up. Results: The young adult CM patients had a significantly higher incidence of headache as the clinical presentation. There were no significant clinical differences between the young adult CM patients with and without AIDS. There were no significant prognostic factors in the young adult CM patients, but the young adult survivors had better outcomes (mRS score 0-2) than the non-young adult group. Conclusion: The young adult CM patients had a higher incidence of headache as the clinical presentation, and the young adult CM survivors had better clinical outcomes.

scholarly journals Clinical Characteristics of the COVID-19 Patients with Pneumonia Detected by Computerized Tomography but Negative for Infiltration by X-ray

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 518
Author(s):  
Dilaram Acharya ◽  
Jungi Park ◽  
Yebong Lee ◽  
In Suk Hamm ◽  
Dong Seok Lee ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Computerized Tomography ◽  
Clinical Characteristics ◽  
Serum Albumin Level ◽  
Albumin Level ◽  
Lung Lesion ◽  
Diagnostic Tools ◽  
Active Lesion ◽  
Laboratory Findings ◽  
X Ray

Coronavirus Disease 2019 (COVID-19) has rapidly spread to all corners of the globe. Different diagnostic tools, such as Chest X-ray (CXR), lung ultrasound (LUS), and computerized tomography (CT), have been used to detect active pneumonic lesions associated with COVID-19 with their varying degrees of sensitivity and specificity. This study was undertaken to investigate the clinical characteristics of COVID-19 patients with a pneumonic lung lesion detected by CT that is not detected by CXR. A total of 156 COVID-19 patients hospitalized at three nationally designated South Korean hospitals with no active lesion detected by CXR but on clinical suspicion of pneumonia underwent the CT examination and were enrolled. Medical records, which included demographic and clinical features, including comorbidity, symptoms, radiological, and laboratory findings on admission, were reviewed and analyzed. The risk factors of pneumonia detected by CT for patients without an active lesion detected by CXR were investigated. Of the 156 patients without an active lesion detected by CXR, 35 (22.44%) patients were found to have pneumonia by CT. The patients with pneumonia defined by CT were older than those without (64.1 years vs. 41.2 years). Comorbidities such as hypertension, diabetes, cardiovascular disease, preexisting stroke, and dementia were more common among patients with pneumonia defined by CT than those without. Serum albumin level, C-reactive protein (CRP), stroke, and age ≥ 70 years were significantly associated with pneumonia defined by CT after adjustment for age. In multivariable regression analysis, serum albumin level (adjusted odds ratio (AOR) = 0.123, 95% CI = (0.035–0.429)) and preexisting stroke (AOR = 11.447, 95% CI = (1.168–112.220)) significantly and independently predicted pneumonia detection by CT. Our results suggest that CT scans should be performed on COVID-19 patients negative for a pneumonic lung lesion by CXR who are suspected to be pneumonic on clinical grounds. In addition, older patients with a lower albumin level and a preexisting stroke should be checked for the presence of pneumonia despite a negative CXR finding for an active lesion.

scholarly journals Cryptococcal meningitis in apparently immunocompetent patients: association with idiopathic CD4+ lymphopenia

2017 ◽  
Vol 18 (2) ◽  
pp. 166-169 ◽  
Author(s):  
Samuel Shribman ◽  
Alastair Noyce ◽  
Sharmilee Gnanapavan ◽  
Jonathan Lambourne ◽  
Thomas Harrison ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Emergency Departments ◽  
Cryptococcal Antigen ◽  
Management Problems ◽  
Antigen Tests ◽  
Lymphocytic Meningitis ◽  
Immunocompetent Patients ◽  
Hiv Negative ◽  
New Onset

We present two cases of cryptococcal meningitis in people subsequently diagnosed with idiopathic CD4+ lymphopenia. Both presented with new onset headaches without sinister features and were sent home on multiple occasions from emergency departments. Cryptococcal meningitis in HIV-negative patients poses major diagnostic and management problems; the associated mortality is 9%–27%. We suggest performing blood and cerebrospinal fluid cryptococcal antigen tests in all people with lymphocytic meningitis.

Cerebrospinal fluid 14-3-3-γ protein level in eight HIV-negative cryptococcal meningitis adults

2008 ◽  
Vol 15 (4) ◽  
pp. 428-430 ◽  
Author(s):  
W. N. Chang ◽  
C. H. Lu ◽  
C. R. Huang ◽  
Y. C. Chuang ◽  
N. W. Tsai ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Protein Level ◽  
Cryptococcal Meningitis ◽  
Hiv Negative

scholarly journals The clinical profiles and outcomes of HIV-negative cryptococcal meningitis patients in type II diabetes mellitus

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hang Li ◽  
Xiaojing Li ◽  
Lei Zhang ◽  
Wenjie Fang ◽  
Keming Zhang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cerebrospinal Fluid ◽  
Cryptococcal Meningitis ◽  
Type Ii Diabetes ◽  
Type Ii Diabetes Mellitus ◽  
Nausea And Vomiting ◽  
Type Ii ◽  
Clinical Profiles ◽  
Visual Disorders ◽  
Hiv Negative

Abstract Background The clinical profiles and outcomes of cryptococcal meningitis have been shown to vary depending on the underlying condition. The aim of this study was to investigate clinical characteristics and outcomes in patients with and without type II diabetes mellitus. Methods A retrospective study was performed. Clinical data of HIV-negative cryptococcal meningitis patients with type II diabetes mellitus (n = 26) and without type II diabetes mellitus (n = 52) referring to the Jiangxi Chest Hospital between January 2012 to December 2018 were analyzed. The data were analyzed using chi square, none-parametric tests, and logistic regression. P-values < 0.05 were considered significant. Results In this study, cryptococcal meningitis patients suffering from type II diabetes mellitus had a higher mortality (23.08% vs. 7.69%; P = 0.055), and required longer hospitalization (59.58 vs. 42.88 days; P = 0.132). Moreover, cerebrospinal fluid examinations revealed that cryptococcal meningitis patients with type II diabetes mellitus had higher opening pressure (271.54 vs. 234.23 mmH2O; P = 0.125).The results of multivariate regression analysis revealed that cryptococcal meningitis patients with type II diabetes were more often presented with visual disorders (28.54% vs. 11.54%; [95% CI 0.056–0.705]; p = 0.012), and had higher cerebrospinal fluid protein levels (1027.62 ± 594.16 vs. 705.72 ± 373.88 mg/l; [95% CI 1.000–1.002]; p = 0.016). Among patients with type II diabetes mellitus, nausea and vomiting was more frequent at the initial visit in those died (100% vs. 50%; p = 0.027), and 66% of died type II diabetes mellitus patients were poorly controlled blood glucose level, compared with 30% in survival type II diabetes mellitus patients. Conclusion This study suggests that cryptococcal meningitis patients with type II diabetes mellitus differ significantly from cryptococcal meningitis patients without type II diabetes mellitus with respect to clinical symptoms such as visual disorders and cerebrospinal fluid examination. The presence of nausea and vomiting among type II diabetes mellitus patients could have implication in mortality.

scholarly journals Prognostic factors predicting a fatal outcome in HIV-negative children with neurotuberculosis

2010 ◽  
Vol 68 (5) ◽  
pp. 755-760 ◽  
Author(s):  
Murilo Gimenes Rodrigues ◽  
Jaime Lin ◽  
Marcelo Rodrigues Masruha ◽  
Luiz Celso Pereira Vilanova ◽  
Thais Soares Cianciarullo Minett
Keyword(s):  
Prognostic Factors ◽  
Close Contact ◽  
Infected Individual ◽  
Multiple Logistic Regression Analysis ◽  
Fatal Outcome ◽  
Miliary Tuberculosis ◽  
Laboratory Findings ◽  
Purified Protein Derivative ◽  
Clinical Records ◽  
Hiv Negative

OBJECTIVE: To identify prognostic factors predicting a fatal outcome in HIV-negative children with neurotuberculosis based on clinical, epidemiological, and laboratory findings. METHOD: The clinical records of all in-patients diagnosed with neurotuberculosis from 1982 to 2005 were evaluated retrospectively. The following prognostic parameters were examined: gender, age, close contact with a tuberculosis-infected individual, vaccination for bacillus Calmette-Guérin, purified protein derivative (PPD) of tuberculin results, concomitant miliary tuberculosis, seizures, CSF results, and hydrocephalus. RESULTS: One hundred forty-one patients diagnosed with neurotuberculosis were included. Seventeen percent of the cases resulted in death. The factors that were correlated with a negative outcome included lack of contact with a tuberculosis-infected individual, negative PPD reaction, coma, and longer hospitalisation time. A multiple logistic regression analysis was performed to identify which of these factors most often resulted in death. CONCLUSION: Coma at diagnosis, lack of tuberculosis contact, and a non-reactive PPD were the most important predictors of fatality in patients with neurotuberculosis

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