AAIT:a Novel Prognostic Model For HIV-negative Cryptococcal Meningitis Patients

Objective: To study the clinical characteristics and prognosis of HIV-negative cryptococcal Meningitis(CM)patients;to study the risk factors that can predict HIV-negative CM patients and to establish a new prognostic model;to verify the accuracy of AAIT model in predicting the prognosis of HIV-negative CM patients.Methods: In the first study,we retrospectively analyzed 381 patients with cryptococcal meningitis diagnosed in the First Affiliated Hospital of Zhejiang University from January 1,2011 to January 31,2018.The HIV-negative cryptococcal meningitis was finally included in the study 201 patients were used to study the prognostic risk factors and establish AAIT prognostic models.In the second study,we used a prospective cohort study method.From February 1,2018 to December 31,2018,a total of 21 HIV-negative cryptocephalic patients were recruited to validate the AAIT model.Accuracy.At the same time,we elaborated the relationship between the prognostic score of cryptocrypt and 1-year mortality.Results: AAIT was a new prognostic score based on age,albumin,other infections,and total triiodothyronine(TT3),significantly higher in non-survivors than in survivors(0.68(-0.70-1.55)vs-1.72(-3.75-(-0.73)),P < 0.00).The of AUROC one-year mortality of AAIT was 0.857,and that of one-year mortality of AAIT was0.965 in the validation cohort.We also found that there was no significant difference between the combination of amphotericin B + 5-fluorocytosine and the combination of amphotericin B + 5-fluorocytosine + fluconazole in the induction period.We also found that there was no significant difference in the effect of amphotericin B +5-fluorocytosine combination and amphotericin B + 5-fluorocytosine + fluconazole combination on disease prognosis in the treatment of the induction period.At the same time,the use of dexamethasone between the two groups was not conducive to improvement in one-year mortality.Conclusion: The prognostic score of AAIT is simple and clear,which provides great help for the prognosis of CM patients.In addition,controlling infection and increasing albumin and TT3 may help improve the clinical outcome of CM.In HIV-negative CM patients,the addition of fluconazole and dexamethasone during the induction period did not significantly improve one-year mortality.