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Meta-Analysis
. 2016 Sep 7;5(9):e95.
doi: 10.1038/emi.2016.93.

Cryptococcal meningitis in systemic lupus erythematosus patients: pooled analysis and systematic review

Wenjie Fang  1   2 , Min Chen  1   2   3 , Jia Liu  1   2 , Ferry Hagen  4 , Abdullah Ms  1 , Al-Hatmi  5 , Peilian Zhang  6 , Yun Guo  6 , Teun Boekhout  1   2   3 , Danqi Deng  6 , Jianping Xu  7 , Weihua Pan  1   2 , Wanqing Liao  1   2
Affiliations
Meta-Analysis

Cryptococcal meningitis in systemic lupus erythematosus patients: pooled analysis and systematic review

Wenjie Fang et al. Emerg Microbes Infect. .

Abstract

Cryptococcal meningitis is an important fungal infection among systemic lupus erythematosus patients. We conducted a pooled analysis and systematic review to describe the epidemiological and clinical profile of cryptococcal meningitis in systemic lupus erythematosus patients. From two hospitals in China and nine literature databases, cases and prevalence data were collected for pooled analysis and meta-analysis, respectively. Categorical variables of cases were compared using a χ(2)-test on the statistical program of SAS. A multiple regression analysis was performed to ascertain independent predictors significantly correlated with prognosis. Meta-analysis was conducted by the statistical program of R. The prevalence of cryptococcal meningitis in systemic lupus erythematosus patients was 0.5%. Patients were predominantly females and adults. A prednisone equivalent of more than 30 mg/day before infection was associated with higher mortality (odds ratio (OR)=9.69 (1.54, 60.73)). In all, 36.8-38.9% patients showed low lupus activity when they developed the crytococcal infection. Moreover, 38.2% of the patients were misdiagnosed. The estimated case-fatality rate was 23.6%. Our results suggest that more emphasis should be placed to further understand lupus-related cryptococcal meningitis and to develop better prophylaxis and management strategies to combat this condition.

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Figures

Figure 1
Figure 1
Flow diagram of study selection. China National Knowledge Infrastructure, CNKI; Chinese Biomedical Literature Service System, SinoMed.
Figure 2
Figure 2
Global distribution of cases. Thirty-seven cases were collected from Asia, 13 from Americas and five from Europe. Fourteen cases were reported before 1999, 16 from 2000 to 2009 and 25 after 2010.
Figure 3
Figure 3
Prevalence of cryptococcal meningitis in systemic lupus erythematosus.
See this image and copyright information in PMC

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