Analysis Of Clinical Data And Influencing Factors Of Prognostic In Patients With HIV-negative Cryptococcal Meningitis

?Objective?To explore the clinical characteristics and prognostic factors of HIV-negative cryptococcal meningitis?CM?,and provide reference for early diagnosis,early treatment and improvement of prognosis.?Methods?A retrospective analysis of 53 cases of HIV-negative CM admitted to Zhongshan Hospital Affiliated to Xiamen University from February 2011 to February2018,including general information,past history,and clinical manifestations,early imaging examination,cerebrospinal fluid?CSF?examination results,diagnosis and treatment.Patients were divided into susceptible group and non-susceptible group according to the presence or absence of predisposing factors.The clinical characteristics of the two groups were analyzed and compared.All patients were treated with anti-Cryptococcus after definite diagnosis.After 3 months of follow-up,the Glasgow Outcome Scale?GOS?was used to evaluate the treatment results,and the factors affecting prognosis were counted by univariate and multivariate analysis.?Results?Among the 53 patients,36?67.9%?were male and 17?32.1%?were female,aged from 12 to 81 years old.Except for 8 patients?15.1%?with no definite history,the other patients were all complicated with different types and degrees of basic diseases,mainly including rheumatoid immuno-related diseases,diabetes,hepatitis B virus,etc.and long-term use of hormones or immunosuppressive agents in 8 cases?15.1%?.The main clinical manifestations were headache?84.9%?,vomiting?41.5%?,fever?32.1%?,disturbance of consciousness?22.6%?,and meninges stimulation?64.2%?.For the first lumbar puncture examination,77.4%of the patients had intracranial pressure higher than180 mmH₂O,and the white blood cells in the CSF were dominated by mononuclear cells,all of which showed varying degrees of elevation,with the maximum value of 611×10⁶/L and the minimum value of 24×10⁶/L.CSF protein content increased in 98.1%of patients,and the ratio of CSF sugar to blood glucose decreased in 77.4%of patients.The probability of positive ink staining was 50.9%and that of positive cryptococcus antigen was 88%.Head imaging examination was positive in 73.6%of the patients within one week after admission,including hydrocephalus or ventricle enlargement in 11 cases?20.8%?,parenchymal involvement in 12 cases?22.6%?and meningeal enhancement in15 cases?28.3%?.The time of onset?p=0.001?and the time from onset to diagnosis?p=0.002?were significantly longer in the non-susceptible group?22 cases,41.5%?than in the susceptible group?31 cases,58.5%?,and meningeal fortification was more likely to occur in the early imaging manifestations?p=0.020?.Good prognosis group?GOS score=4 to 5,n=36?and poor prognosis group?GOS score=1-3,n=17?,single factor analysis showed that the pre-hospital fever,do you have any hydrocephalus or ventricle enlarge CSF monocyte percentage for the first time,lumbar puncture,CSF sugar,lactic acid,lactic acid dehydrogenase,chloride,CSF ratio of sugar and blood sugar,the admission to the sense of time,presence of cultivate of confirmed diagnosis,to the time of diagnosis is the factors affecting the prognosis of disease.Moreover,Multivariate analysis showed that fever before admission?OR=48.6,95%CI:2.8,838.6?and dehydrogenase level in first CSF examination?OR=1.094,95%CI:1.0,1.2?are independent predictors of poor prognosis in HIV-negative CM.?Conclusion?HIV-negative CM is more common in older men with induced factors,with headache,vomiting,fever,and disturbance of consciousness as the main manifestations.The initial symptoms of the disease are often atypical,and the onset time and time from onset to diagnosis of the patients in the non-susceptible group are significantly longer than those in the susceptible group,and the early imaging manifestations are more prone to meningeal enhancement.CSF cryptococcal antigen examination can significantly improve the diagnostic efficiency of CM.Fever before admission and dehydrogenase level in first CSF examination are independent predictors of poor prognosis in HIV-negative CM.