Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery

OBJECTIVECervical deformity (CD) correction is clinically challenging. There is a high risk of developing complications with these highly complex procedures. The aim of this study was to use baseline demographic, clinical, and surgical factors to predict a poor outcome following CD surgery.METHODSThe authors performed a retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: cervical kyphosis (C2–7 Cobb angle > 10°), cervical scoliosis (coronal Cobb angle > 10°), C2–7 sagittal vertical axis (cSVA) > 4 cm, or chin-brow vertical angle (CBVA) > 25°. Patients were categorized based on having an overall poor outcome or not. Health-related quality of life measures consisted of Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale scores. A poor outcome was defined as having all 3 of the following categories met: 1) radiographic poor outcome: deterioration or severe radiographic malalignment 1 year postoperatively for cSVA or T1 slope–cervical lordosis mismatch (TS-CL); 2) clinical poor outcome: failing to meet the minimum clinically important difference (MCID) for NDI or having a severe mJOA Ames modifier; and 3) complications/reoperation poor outcome: major complication, death, or reoperation for a complication other than infection. Univariate logistic regression followed by multivariate regression models was performed, and internal validation was performed by calculating the area under the curve (AUC).RESULTSIn total, 89 patients with CD were included (mean age 61.9 years, female sex 65.2%, BMI 29.2 kg/m2). By 1 year postoperatively, 18 (20.2%) patients were characterized as having an overall poor outcome. For radiographic poor outcomes, patients’ conditions either deteriorated or remained severe for TS-CL (73% of patients), cSVA (8%), horizontal gaze (34%), and global SVA (28%). For clinical poor outcomes, 80% and 60% of patients did not reach MCID for EQ-5D and NDI, respectively, and 24% of patients had severe symptoms (mJOA score 0–11). For the complications/reoperation poor outcome, 28 patients experienced a major complication, 11 underwent a reoperation, and 1 had a complication-related death. Of patients with a poor clinical outcome, 75% had a poor radiographic outcome; 35% of poor radiographic and 37% of poor clinical outcome patients had a major complication. A poor outcome was predicted by the following combination of factors: osteoporosis, baseline neurological status, use of a transition rod, number of posterior decompressions, baseline pelvic tilt, T2–12 kyphosis, TS-CL, C2–T3 SVA, C2–T1 pelvic angle (C2 slope), global SVA, and number of levels in maximum thoracic kyphosis. The final model predicting a poor outcome (AUC 86%) included the following: osteoporosis (OR 5.9, 95% CI 0.9–39), worse baseline neurological status (OR 11.4, 95% CI 1.8–70.8), baseline pelvic tilt > 20° (OR 0.92, 95% CI 0.85–0.98), > 9 levels in maximum thoracic kyphosis (OR 2.01, 95% CI 1.1–4.1), preoperative C2–T3 SVA > 5.4 cm (OR 1.01, 95% CI 0.9–1.1), and global SVA > 4 cm (OR 3.2, 95% CI 0.09–10.3).CONCLUSIONSOf all CD patients in this study, 20.2% had a poor overall outcome, defined by deterioration in radiographic and clinical outcomes, and a major complication. Additionally, 75% of patients with a poor clinical outcome also had a poor radiographic outcome. A poor overall outcome was most strongly predicted by severe baseline neurological deficit, global SVA > 4 cm, and including more of the thoracic maximal kyphosis in the construct.

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The Prognostic Value of CT Angiography and CT Perfusion in Acute Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000441088 ◽

2015 ◽

Vol 40 (5-6) ◽

pp. 258-269 ◽

Cited By ~ 39

Author(s):

Tom van Seeters ◽

Geert Jan Biessels ◽

L. Jaap Kappelle ◽

Irene C. van der Schaaf ◽

Jan Willem Dankbaar ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Ct Angiography ◽

Predictive Value ◽

Prognostic Value ◽

Ct Perfusion ◽

Patient Characteristics ◽

Poor Clinical Outcome ◽

Poor Outcome

Background: CT angiography (CTA) and CT perfusion (CTP) are important diagnostic tools in acute ischemic stroke. We investigated the prognostic value of CTA and CTP for clinical outcome and determined whether they have additional prognostic value over patient characteristics and non-contrast CT (NCCT). Methods: We included 1,374 patients with suspected acute ischemic stroke in the prospective multicenter Dutch acute stroke study. Sixty percent of the cohort was used for deriving the predictors and the remaining 40% for validating them. We calculated the predictive values of CTA and CTP predictors for poor clinical outcome (modified Rankin Scale score 3-6). Associations between CTA and CTP predictors and poor clinical outcome were assessed with odds ratios (OR). Multivariable logistic regression models were developed based on patient characteristics and NCCT predictors, and subsequently CTA and CTP predictors were added. The increase in area under the curve (AUC) value was determined to assess the additional prognostic value of CTA and CTP. Model validation was performed by assessing discrimination and calibration. Results: Poor outcome occurred in 501 patients (36.5%). Each of the evaluated CTA measures strongly predicted outcome in univariable analyses: the positive predictive value (PPV) was 59% for Alberta Stroke Program Early CT Score (ASPECTS) ≤7 on CTA source images (OR 3.3; 95% CI 2.3-4.8), 63% for presence of a proximal intracranial occlusion (OR 5.1; 95% CI 3.7-7.1), 66% for poor leptomeningeal collaterals (OR 4.3; 95% CI 2.8-6.6), and 58% for a >70% carotid or vertebrobasilar stenosis/occlusion (OR 3.2; 95% CI 2.2-4.6). The same applied to the CTP measures, as the PPVs were 65% for ASPECTS ≤7 on cerebral blood volume maps (OR 5.1; 95% CI 3.7-7.2) and 53% for ASPECTS ≤7 on mean transit time maps (OR 3.9; 95% CI 2.9-5.3). The prognostic model based on patient characteristics and NCCT measures was highly predictive for poor clinical outcome (AUC 0.84; 95% CI 0.81-0.86). Adding CTA and CTP predictors to this model did not improve the predictive value (AUC 0.85; 95% CI 0.83-0.88). In the validation cohort, the AUC values were 0.78 (95% CI 0.73-0.82) and 0.79 (95% CI 0.75-0.83), respectively. Calibration of the models was satisfactory. Conclusions: In patients with suspected acute ischemic stroke, admission CTA and CTP parameters are strong predictors of poor outcome and can be used to predict long-term clinical outcome. In multivariable prediction models, however, their additional prognostic value over patient characteristics and NCCT is limited in an unselected stroke population.

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LncRNA RHPN1-AS1 promotes cholangiocarcinoma progression and predicts poor clinical outcome through miR-345-5p/YAP1 axis

10.21203/rs.3.rs-58822/v1 ◽

2020 ◽

Author(s):

Lifeng Ma ◽

Tao Li ◽

Guochao Liu ◽

Jianlong Wang ◽

Zhaoqiang Yin ◽

...

Keyword(s):

Cell Proliferation ◽

Clinical Practice ◽

Clinical Outcome ◽

Carcinoma Cell ◽

Poor Clinical Outcome ◽

Xenograft Growth ◽

Poor Outcome ◽

New Strategies

Abstract Background LncRNAs have proven to be involved in the initiation and progression of cholangiocarcinoma (CCA), although the mechanism by which this occurs remains unknown. Methods The current study reveals that RHPN1-AS1 was overexpressed in CCA patient samples, which predicted poor outcome of CCA patients. RHPN1-AS1 increased in vitro pancreatic carcinoma cell proliferation as well as promoted xenograft growth in vivo. Mechanistically, DANCR upregulated expression of YAP1 by competitively binding to miR-345-5p. Importantly, RHPN1-AS1 level was positively correlated with YAP1 expression level in CCA tissues. Moreover, YAP1 overexpression could predicted a poor outcome of CCA patients. Results Taken together, our results suggested that RHPN1-AS1 might be a remarkable biomarker to evaluate prognosis in CCA. Conclusion The RHPN1-AS1/YAP1 axis may provide new strategies for CCA clinical practice.

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Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization – When “tissue clock” and “time clock” are desynchronized

International Journal of Stroke ◽

10.1177/1747493019884522 ◽

2019 ◽

pp. 174749301988452 ◽

Cited By ~ 2

Author(s):

Jawed Nawabi ◽

Fabian Flottmann ◽

Andre Kemmling ◽

Helge Kniep ◽

Hannes Leischner ◽

...

Keyword(s):

Clinical Outcome ◽

Acute Stroke ◽

Water Uptake ◽

Quantitative Imaging ◽

Receiver Operating Curve ◽

Imaging Biomarker ◽

Poor Clinical Outcome ◽

Similar Time ◽

Poor Outcome ◽

Malignant Infarction

Background Ischemic water uptake in acute stroke is a reliable indicator of lesion age. Nevertheless, inter-individually varying edema progression has been observed and elevated water uptake has recently been described as predictor of malignant infarction. Aims We hypothesized that early-elevated lesion water uptake indicates accelerated “tissue clock” desynchronized with “time clock” and therefore predicts poor clinical outcome despite successful recanalization. Methods Acute middle cerebral artery stroke patients with multimodal admission-CT who received successful thrombectomy (TICI 2b/3) were analyzed. Net water uptake (NWU), a quantitative imaging biomarker of ischemic edema, was determined in admission-CT and tested as predictor of clinical outcome using modified Rankin Scale (mRS) after 90 days. A binary outcome was defined for mRS 0–4 and mRS 5–6. Results Seventy-two patients were included. The mean NWU (SD) in patients with mRS 0–4 was lower compared to patients with mRS 5–6 (5.0% vs. 12.1%; p < 0.001) with similar time from symptom onset to imaging (2.6 h vs. 2.4 h; p = 0.7). Based on receiver operating curve analysis, NWU above 10% identified patients with very poor outcome with high discriminative power (AUC 0.85), followed by Alberta Stroke Program Early CT Score (ASPECTS) (AUC: 0.72) and National Institutes of Health Stroke Scale (NIHSS) (AUC: 0.72). Conclusions Quantitative NWU may serve as an indicator of “tissue clock” and pronounced early brain edema with elevated NWU might suggest a desynchronized “tissue clock” with real “time clock” and therefore predict futile recanalization with poor clinical outcome.

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The effect of direct vertebral rotation on the spine parameters (coronal and sagittal) in adolescent idiopathic scoliosis

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200320 ◽

2021 ◽

pp. 1-8

Author(s):

Carlos Eduardo Gonçales Barsotti ◽

Carlos Augusto Belchior B. Junior ◽

Rodrigo Mantelatto Andrade ◽

Alexandre Penna Torini ◽

Ana Paula Ribeiro

Keyword(s):

Idiopathic Scoliosis ◽

Cobb Angle ◽

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Pelvic Tilt ◽

Pelvic Incidence ◽

Vertebral Rotation ◽

Sacral Slope ◽

Post Surgery ◽

Radiographic Parameters

BACKGROUND: Idiopathic scoliosis is accompanied by postural alterations, instability of gait, and functional disabilities. The objective was to verify radiographic parameters (coronal and sagittal) of adolescents with idiopathic scoliosis (AIS) pre- and post-surgery with direct vertebral rotation (DVR), associated with type 1 osteotomies in all segments (except the most proximal) and type 2 in the periapical vertebrae of the curves. METHODS: A prospective study design was employed in which 41 AIS were evaluated and compared pre- and post-surgery. Scoliosis was confirmed by a spine X-ray exam (Cobb angle). Eight radiographic parameters were measured: Cobb angles (thoracic proximal and distal), segmental kyphosis, total kyphosis, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. RESULTS: The Cobb angle averaged 51.3∘± 14.9∘. Post-surgery, there were significant reductions for the following spine measurement parameters: Cobb angle thoracic proximal (p= 0.003); Cobb angle thoracic distal (p= 0.001); Cobb angle lumbar (p= 0.001); kyphosis (T5-T12, p= 0.012); and kyphosis (T1-T12, p= 0.002). These reductions showed the effectiveness of surgical correction to reduce Cobb angles and improve thoracic kyphosis. The values obtained for lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt were not significantly different pre- and post-surgery. CONCLUSION: The surgical technique of DVR in AIS proved to be effective in the coronal and sagittal parameters directed at Cobb angles and thoracic kyphosis in order to favor the rehabilitation process.

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Neutrophil count predicts poor outcome despite recanalization after endovascular therapy

Neurology ◽

10.1212/wnl.0000000000007859 ◽

2019 ◽

Vol 93 (5) ◽

pp. e467-e475 ◽

Cited By ~ 8

Author(s):

William Boisseau ◽

Jean-Philippe Desilles ◽

Robert Fahed ◽

Maeva Kyheng ◽

Kevin Zuber ◽

...

Keyword(s):

Blood Glucose ◽

Clinical Outcome ◽

Scale Score ◽

Endovascular Therapy ◽

Neutrophil Count ◽

Experimental Studies ◽

Poor Clinical Outcome ◽

High Blood Glucose ◽

Poor Outcome ◽

Unit Increase

ObjectiveTo identify early prognostic factors of poor clinical outcome in patients treated by endovascular therapy (EVT) with successful recanalization.MethodsWe reviewed our monocentric prospectively collected EVT database of patients with anterior circulation acute ischemic stroke (AIS) from January 2016 to April 2018 who had achieved successful recanalization (Thrombolysis in Cerebral Infarction score ≥ 2b) at the end of the procedure. A poor outcome was defined as a 3-month modified Rankin Scale score of ≥3.ResultsA total of 324 patients were included, among whom 186 (57.4%) had a poor outcome. Multivariate logistic regression indicated that age (per 10-year increase, odds ratio [OR] 1.34, 95% confidence interval [CI] 1.12–1.60), baseline NIH Stroke Scale score (per 1-unit increase, OR 1.09, 95% CI 1.04–1.15), initial infarct volume (per a log+1 increase, OR 1.34, 95% CI 1.05–1.67), blood glucose level (per a log+1 increase, OR 2.60, 95% CI 1.01–6.66), and neutrophil count (per 1,000-unit increase, OR 1.08, 95% CI 1.01–1.17) were all associated with poor clinical outcome.ConclusionsIn addition to baseline severe AIS criteria, high neutrophil count and high blood glucose, known from experimental studies to be associated with downstream microvascular thromboinflammation, are independently associated with poor outcome. These findings support a deleterious role of thromboinflammation in patient recovery despite successful recanalization.

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Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection

Scientific Reports ◽

10.1038/s41598-021-00927-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lior Prozan ◽

Eden Shusterman ◽

Jacob Ablin ◽

Alexis Mitelpunkt ◽

Ahuva Weiss-Meilik ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Prognostic Factor ◽

Virus Infection ◽

Clinical Outcome ◽

Respiratory Syncytial Virus Infection ◽

Roc Curve ◽

Prognostic Value ◽

Poor Clinical Outcome ◽

Syncytial Virus ◽

Poor Outcomes

AbstractA high neutrophil to lymphocyte ratio (NLR) is considered an unfavorable prognostic factor in various diseases, including COVID-19. The prognostic value of NLR in other respiratory viral infections, such as Influenza, has not hitherto been extensively studied. We aimed to compare the prognostic value of NLR in COVID-19, Influenza and Respiratory Syncytial Virus infection (RSV). A retrospective cohort of COVID-19, Influenza and RSV patients admitted to the Tel Aviv Medical Center from January 2010 to October 2020 was analyzed. Laboratory, demographic, and clinical parameters were collected. Two way analyses of variance (ANOVA) was used to compare the association between NLR values and poor outcomes among the three groups. ROC curve analyses for each virus was applied to test the discrimination ability of NLR. 722 COVID-19, 2213 influenza and 482 RSV patients were included. Above the age of 50, NLR at admission was significantly lower among COVID-19 patients (P < 0.001). NLR was associated with poor clinical outcome only in the COVID-19 group. ROC curve analysis was performed; the area under curve of poor outcomes for COVID-19 was 0.68, compared with 0.57 and 0.58 for Influenza and RSV respectively. In the COVID-19 group, multivariate logistic regression identified a high NLR (defined as a value above 6.82) to be a prognostic factor for poor clinical outcome, after adjusting for age, sex and Charlson comorbidity score (odds ratio of 2.9, P < 0.001). NLR at admission is lower and has more prognostic value in COVID-19 patients, when compared to Influenza and RSV.

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Prognostic value of Neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection

10.21203/rs.3.rs-130833/v1 ◽

2020 ◽

Author(s):

Lior Prozan ◽

Eden Shusterman ◽

Jacob Ablin ◽

Alexis Mitelpunkt ◽

Ahuva Weiss-Meilik ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Prognostic Factor ◽

Virus Infection ◽

Clinical Outcome ◽

Respiratory Syncytial Virus Infection ◽

Roc Curve ◽

Prognostic Value ◽

Poor Clinical Outcome ◽

Syncytial Virus ◽

Poor Outcomes

Abstract Background: A high Neutrophil to Lymphocyte Ratio (NLR) is considered an unfavorable prognostic factor in various diseases, including COVID-19. The prognostic value of NLR in other respiratory viral infections, such as Influenza, has not hitherto been extensively studied. We aimed to compare the prognostic value of NLR in COVID-19, Influenza and Respiratory Syncytial Virus infection (RSV).Method: A retrospective cohort of COVID-19, Influenza and RSV patients admitted to the Tel Aviv Medical Center from January 2010 to October 2020 was analyzed. Laboratory, demographic, and clinical parameters were collected. Two way analyses of variance (ANOVA) was used to compare the association between NLR values and poor outcomes among the three groups. ROC curve analyses for each virus was applied to test the discrimination ability of NLR. Results: 722 COVID-19, 2213 influenza and 482 RSV patients were included. Above the age of 50, NLR at admission was significantly lower among COVID-19 patients (P<0.001). NLR was associated with poor clinical outcome only in the COVID-19 group. ROC curve analysis was performed; the area under curve of poor outcomes for COVID-19 was 0.643, compared with 0.497 and 0.537 for Influenza and RSV respectively. In the COVID-19 group, multivariate logistic regression identified a high NLR (defined as a value above 4.7) to be a prognostic factor for poor clinical outcome, after adjusting for age, sex and Charlson comorbidity score (odds ratio of 1.6, P=0.005). Conclusions: NLR at admission is lower and has more prognostic value in COVID-19 patients, when compared to Influenza and RSV.

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Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-015889 ◽

2020 ◽

Vol 13 (1) ◽

pp. 14-18 ◽

Cited By ~ 5

Author(s):

Noel van Horn ◽

Helge Kniep ◽

Hannes Leischner ◽

Rosalie McDonough ◽

Milani Deb-Chatterji ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Logistic Regression Analysis ◽

Stroke Severity ◽

Stroke Patients ◽

Poor Clinical Outcome ◽

Poor Outcome

BackgroundIn patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.MethodsPatients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3–6 was defined as ‘poor outcome’. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.Results123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.ConclusionPoor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.

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Outcome of Schizophrenia: The Madras Longitudinal Study

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048679609065026 ◽

1996 ◽

Vol 30 (4) ◽

pp. 516-522 ◽

Cited By ~ 40

Author(s):

Rangaswamy Thara ◽

William W. Eaton

Keyword(s):

Clinical Outcome ◽

First Episode ◽

Poor Clinical Outcome ◽

Poor Outcome ◽

Schizophrenic Patients ◽

Steep Decline ◽

And Gender ◽

Almost All ◽

Social Demographic

Objective: The aim of the study was to determine the clinical outcome in a group of first-episode schizophrenic patients on a 10-year follow-up. The social, demographic and clinical variables associated with poor outcome and gender differences in outcome were other issues addressed. Method: Ninety patients fulfilling Feighner's and ICD-9 criteria for schizophrenia, at Madras, India, were included for a 10-year follow-up. The Present State Examination and the Psychiatric and Personal schedule were administered at intake and at the end of every year. Clinical outcome was considered as a combination of the pattern of course and the presence of positive symptoms during year 10. Results: After 10 years, 76 of the 90 patients included were followed up, giving a follow-up rate of 84%. The clinical outcome was good in nearly 75% of the patients with almost all symptoms showing a steep decline at the end of 10 years. Fifty-nine subjects were asymptomatic at the end of the follow-up period and 12 were ill during the entire 10th year. Sexual, religious and grandiose delusions and flat affect at inclusion predicted a poor clinical outcome. More males had a poor outcome and spent a longer time in a psychotic state. Conclusions: There is evidence of a good outcome in the majority of first-episode schizophrenic patients after 10 years in keeping with other reports from developing countries. Certain variables at inclusion predicted a poor clinical outcome and males had a poorer outcome than females.

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Predictors of poor clinical outcome of cryptococcal meningitis in HIV-infected patients

International Journal of STD & AIDS ◽

10.1258/ijsa.2011.010538 ◽

2011 ◽

Vol 22 (11) ◽

pp. 665-670 ◽

Cited By ~ 21

Author(s):

◽

T Anekthananon ◽

W Manosuthi ◽

P Chetchotisakd ◽

S Kiertiburanakul ◽

...

Keyword(s):

Clinical Outcome ◽

Amphotericin B ◽

Cryptococcal Meningitis ◽

Karnofsky Performance Status ◽

Performance Status ◽

High Dose ◽

Poor Clinical Outcome ◽

Poor Outcome ◽

Low Weight ◽

Baseline Characteristics

The aim of this study was to identify baseline prognostic factors for poor clinical outcome of HIV-associated cryptococcal meningitis. We conducted a trial in Thailand and the USA comparing low- and high-dose concomitant use of amphotericin B and fluconazole for HIV-associated cryptococcal meningitis to amphotericin B followed by fluconazole. Subjects who were either alive and cerebrospinal fluid (CSF) culture-positive or dead were considered to have a poor outcome. At day 14, baseline characteristics associated with poor outcome included: low weight, high CSF cryptococcal antigen (CrAg) titre and low CSF white blood cell (WBC) count. At day 70, the associated baseline characteristics included: CSF CrAg titre >1:1024 and low Karnofsky performance status. Overall, consistent with published findings, low weight, high CSF CrAg titre and low CSF WBC counts at baseline were predictors for poor clinical outcome. In addition, we found that low Karnofsky performance status was predictive of poor outcome. Prompt management with appropriate antifungal therapy for this particular group of patients may improve the outcomes.

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