Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – a retrospective cohort study

Show simple item record Hiesgen, Juliane Schutte, Clara-Maria Olorunju, S. Retief, J. 2017-04-07T05:46:49Z 2017-04-07T05:46:49Z 2017-06
dc.description.abstract AIM : This retrospective cohort study analyzes the impact of possible risk factors on the survival chance of patients with cryptococcal meningitis. These factors include the patient's socio-economic background, age, gender, presenting symptoms, comorbidities, laboratory findings and, in particular, non-adherence versus adherence to therapy. METHODS : Data were collected from all adult patients admitted to Kalafong Hospital with laboratory confirmed cryptococcal meningitis over a period of 24 months. We analyzed the data by the presentation of descriptive summary statistics, logistic regression was used to assess factors which showed association between outcome of measure and factor. Furthermore, multivariable logistic regression analysis using all the factors that showed significant association in the cross tabulation was applied to determine which factors had an impact on the patients' mortality risk. RESULTS : A total of 87 patients were identified. All except one were HIV-positive, of which 55.2% were antiretroviral therapy naïve. A history of previous tuberculosis was given by 25 patients (28.7%) and 49 (56.3%) were on tuberculosis treatment at admission or started during their hospital stay. In-hospital mortality was 31%. Statistical analysis showed that antiretroviral therapy naïve patients had 9.9 (CI 95% 1.2-81.2, p < 0.0032) times greater odds of dying compared to those on antiretroviral therapy, with 17 from 48 patients (35.4%) dying compared with 1 out of 21 patients (4.8%) on treatment. Defaulters had 14.7 (CI 95% 1.6-131.6, p < 0.016) times greater odds of dying, with 9 from 18 patients dying (50%), compared to the non-defaulters. In addition, patients who presented with nausea and vomiting had a 6.3 (95% CI 1.7-23.1, p < 0.005) times greater odds of dying (18/47, 38.3%); this remained significant when adjusted for antiretroviral therapy naïve patients and defaulters. CONCLUSION : Cryptococcal meningitis is still a common opportunistic infection in people living with HIV/AIDS resulting in hospitalization and a high mortality. Defaulting antiretroviral therapy and presentation with nausea and vomiting were associated with a significantly increased mortality risk. en_ZA
dc.description.department Neurology en_ZA
dc.description.librarian hb2017 en_ZA
dc.description.uri en_ZA
dc.identifier.citation Hiesgen, J, Schutte, C, Olorunju, S & Retief, J 2017, 'Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – a retrospective cohort study', International Journal of STD and AIDS, vol. 28, no. 5, pp. 480-485. en_ZA
dc.identifier.issn 0956-4624
dc.identifier.other 10.1177/0956462416653559
dc.language.iso en en_ZA
dc.publisher Sage en_ZA
dc.rights © 2017 by Sage Publications en_ZA
dc.subject Viral disease en_ZA
dc.subject Acquired immune deficiency syndrome (AIDS) en_ZA
dc.subject Antiretroviral (ARV) en_ZA
dc.title Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – a retrospective cohort study en_ZA
dc.type Postprint Article en_ZA

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