Cryptococcus Infection Network in Non-Human Immunodeficiency Virus Cohort (CINCH) Study: Initial Report of Treatment and Outcomes
Notice bibliographique
Résumé
Background. Cryptococcal infections have been studied in depth in patients with HIV, but outcomes and optimal treatments in other immune-suppressed patients are not well characterized. We performed a large multicenter, prospective cohort study of HIV-negative patients with cryptococcosis with aim to describe the outcomes and treatment practices. Methods. Investigators from 25 strategically placed hospitals throughout the United States assembled to capture cases and report outcomes in a modified prospective cohort study, using internet-based case report forms. Data on comorbidities, predisposing factors, infection characteristics, survival, disability and outcomes were tabulated. Cumulative morbidity was modeled using novel risk methods and recurrent event analyses. Results. Data from 127 of over 150 patients enrolled to date are presented here. Patients were predominantly male (66%), and 101 (82%) were immunocompromised, with most frequent prior therapies including receipt of cytotoxic chemotherapy (n = 77, 61%) and solid organ transplant (n = 38, 30%). Most patients were enrolled from the Southern U.S. region (n = 75, 59%). Disease involved only the lungs in 17 (13%). Diagnosis was delayed beyond 1 month from presentation in a large proportion of patients (26%). Therapy and outcomes were described in 97 patients who were followed prospectively. The majority received a polyene based treatment (63%), with 37% receiving only azoles. Mortality at 100 days was 20%. Prospective outcomes are shown in Figure 1, with each line representing patients. Cumulative neurologic morbidity was significant, both with regards to complications of high-pressure management and functional decline. Serial assessment of Montreal Cognitive Assessment (MoCA) scores showed that patients who were enrolled with impaired cognition (78%) were slow to improve, and some did not return to normal, even after a year of therapy. Conclusion. HIV negative patients with cryptococcosis that involves the CNS have decidedly poor outcomes, especially with consideration of cumulative neurologic morbidity. Methods demonstrated in this study, including use of prospective cohort design and recurrent event analyses to understand cumulative morbidity, provide a useful template to better understand the clinical approach to poorly evaluated infectious diseases. Disclosures. All authors: No reported disclosures.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».