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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