Presentation and prognosis of cryptococcosis requiring intensive care unit admission in France: the CRYPTO-ICU study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Herbel Simon, Paccoud Olivier, de Montmollin Étienne, Grenier Baptiste, Picard Muriel, Vigneron Clara, Osman David, Le Gall Aëlle, Guitard Juliette, Joffre Jérémie, Frapard Thomas, Coirier Valentin, Joseph Adrien, Schmidt Julien, Argaud Laurent, Decavèle Maxens, Lacave Guillaume, Voirot Guillaume, Bellal Mathieu, Neuville Mathilde, Moreau Anne-Sophie, Das Vincent, Agbakou Maïté, Pichereau Claire, Quenot Jean-Pierre, Uhel Fabrice, Le Pape Marc, Meireles Sylvie, Kouatchet Achille, Contou Damien, Persichini Romain, Issa Nahema, Mokart Djamel, Lortholary Olivier, Azoulay Elie, Lanternier Fanny, Bigé Naïke
Аннотация
METHODS: We conducted a retrospective, multicenter study of patients admitted to 30 French ICUs for severe cryptococcosis between 2000 and 2022.
RESULTS: Among 151 patients included, 56.9% were patients with HIV. Cases in patients without HIV became increasingly prevalent over time (51.3% in 2012-2022 vs. 32.4% before 2012); 82.5% were receiving immunosuppressive therapy. Central nervous system infection was predominant (91.1%), followed by lung infection (39.7%). Fungemia occurred in 59.8% patients, and 75.2% had disseminated infection. Neurological failure was the leading organ impairment at admission (75.5%) followed by respiratory failure (47.7%), acute kiney injury (41.7%) and shock (24.5%). The median SOFA score was 4 [2-7]. Invasive mechanical ventilation, vasopressors and renal replacement therapy were required in 54.9%, 34.4% and 18.5% of patients, respectively. At day 90, 94% of patients requiring mechanical ventilation and vasopressors were deceased, compared to 38.7% with invasive ventilation alone and 17.2% without any organ support (p<0.001). Overall, 90-day mortality reached 49.6%. SOFA score (HR 1.04 [1.02-1.06]), admission between 2000 and 2012 (HR 2.30 [1.36-3.89]), disseminated infection (HR 2.32 [1.15-4.67]) and initiation of antifungal therapy before ICU admission (HR 0.38 [0.22-0.63]) were independently associated with 90-day mortality, whereas HIV serostatus was not (HR 0.93 [0.47-1.84]).
CONCLUSION: Severe cryptococcosis requiring ICU admission affects an increasing number of patients without HIV and is associated with high, though declining, mortality. Early diagnosis and treatment are mandatory to improve prognosis.