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Description

Brizendine et al identified factors associated with mortality in a patient with a cryptococcal infection. These can help to identify a patient who may benefit from more aggressive management. The authors are from the Cleveland Clinic, Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham.


 

Patient selection: cryptococcosis

 

Parameters:

(1) cryptococcemia

(2) baseline opening pressure of spinal tap in cm H2O

(3) patient group

 

Parameter

Finding

Odds Ratio

cryptococcemia

Absent

1

 

Present

5.1

baseline opening pressure

<= 25 cm H2O

1

 

> 25 cm H2O

2.9

patient group

HIV positive

0.46

 

organ transplant recipient

0.46

 

Other

1

 

where:

• The "other" group included patients with a spectrum of conditions: chronic steroid use, rheumatologic disease, renal insufficiency, non-HIV CD4+ lymphocytopenia, immunoglobulin deficiency and no known underlying disease.

 

cumulative odds ratio for mortality =

= PRODUCT(odds ratios for the 3 parameters)

 

Interpretation:

• minimum cumulative odds ratio for mortality: 0.46

• maximum cumulative odds ratio for mortality: 14.8

 


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