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. 2015 Dec 15;3(1):ofv197.
doi: 10.1093/ofid/ofv197. eCollection 2016 Jan.

End-Stage Liver Disease Is a Strong Predictor of Early Mortality in Cryptococcosis

Andrej Spec  1 , Krunal Raval  2 , William G Powderly  1
Affiliations

End-Stage Liver Disease Is a Strong Predictor of Early Mortality in Cryptococcosis

Andrej Spec et al. Open Forum Infect Dis. .

Abstract

Background. Cryptococcosis in the setting of end-stage liver disease (ESLD) has been associated with high mortality. We sought to compare the outcome of cryptococcal disease in patients with ESLD to that of human immunodeficiency virus (HIV)-positive patients and to those patients without HIV or ESLD. Methods. We assembled a retrospective cohort of 232 consecutive cases of cryptococcosis in our institution, from 2002 to 2014, inclusively. We analyzed the cases for comorbidities, type of infection, and survival. Data were analyzed with t tests, Fishers Exact test, and Kaplan-Meyer analysis. Results. Twenty-five (10.8%) patients with cryptococcal infection had concomitant ESLD; of these, 5 (20%) presented with peritonitis. Most (17 of 25, 68%) did not have any other cause of immunocompromise that has been more classically associated with cryptococcosis. Patients with ESLD had a significantly higher mortality than HIV-positive patients and HIV-negative patients without ESLD (HIVNE) (80% vs 13.6% and 22.7%, respectively; P < .001). In addition, fatal outcome in ESLD patients occurred more rapidly than in HIVNE patients, with a median survival of 6 days (vs 17), despite a comparable time to diagnosis (6.2 vs 6.6 days). Conclusions. Cryptococcosis is an important morbidity in patients with ESLD. Patients with ESLD who are infected with Cryptococcus have a high and rapid mortality. This suggests that a high level of vigilance for cryptococcal infection should be kept in patients with ESLD.

Keywords: Cryptococcus; adult; end-stage live disease (ESLD); prognosis.

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Figures

Figure 1.
Figure 1.
Kaplan-Meier survival curve of 232 patients with cryptococcosis by underlying condition, 2002–2014. Patients with end-stage liver disease (ESLD) had the lowest survival, most dramatically expressed in the first 15 days of the infection. Mortality was censored after 90 days because it was less likely to be related to cryptococcosis; P < .001. Abbreviations: HIV, human immunodeficiency virus; HIVNE, HIV-negative, without ESLD.
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