Analysis Of Clinical Features And Influencing Factors Of Prognosis In Patients With Cryptococcal Meningitis

Objective:To analyze the clinical features and prognostic factors of 124 patients with cryptococcal meningitis.Methods:Investigated 124 patients with cryptococcal meningitis who were admitted to the Infectious Disease Department of the First Affiliated Hospital of Zhejiang University from January 2014 to December 2016,and collected their general data,clinical manifestations,cerebrospinal fluid examination,and treatment to analyze.Results:Among the 124 patients with cryptococcal meningitis,the majority were young and middle-aged males,and 55.65%had more than one underlying disease.Headache and fever were the most common presenting symptoms.The cerebrospinal fluid pressure was elevated in 103 patients(83.06%),94(75.8%)patients' cerebrospinal fluid cell number increased,86(69.35%)patients' cerebrospinal fluid chloride decreased,105(84.68%)patients had elevated cerebrospinal fluid protein levels,whereas 73(58.87%)patients' cerebrospinal fluid sugar content decreased.There were abnormal changes in cranial imaging examinations in 92 patients,including 18 cases of hydrocephalus and cerebral edema.All 124 patients were treated with anti-Cryptococcus,with 82 patients with good prognosis and 42 patients with poor prognosis.Univariate analysis revealed that unconscious disorders(p=0.024),persistent intracranial hypertension(p= 0.015),and combination of treatment(p= 0.000)and duration of treatment(p=0.000)were prognostic factors for cryptococcal meningitis.Multivariate analysis suggested that continuous intracranial hypertension(P=0.003)and monotherapy(P=0.000)were associated with poor prognosis.Conclusions:Sustained intracranial hypertension and monotherapy are independent risk factors for poor prognosis of cryptococcal meningitis.