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Comprehensive risk factor predictions for 3-year survival among HIV-associated and disseminated cryptococcosis involving lungs and central nervous system
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Comprehensive risk factor predictions for 3-year survival among HIV-associated and disseminated cryptococcosis involving lungs and central nervous system
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Journal Article
Comprehensive risk factor predictions for 3-year survival among HIV-associated and disseminated cryptococcosis involving lungs and central nervous system
2024
Overview
Background
The global mortality rate resulting from HIV-associated cryptococcal disease is remarkably elevated, particularly in severe cases with dissemination to the lungs and central nervous system (CNS). Regrettably, there is a dearth of predictive analysis regarding long-term survival, and few studies have conducted longitudinal follow-up assessments for comparing anti-HIV and antifungal treatments.
Methods
A cohort of 83 patients with HIV-related disseminated cryptococcosis involving the lung and CNS was studied for 3 years to examine survival. Comparative analysis of clinical and immunological parameters was performed between deceased and surviving individuals. Subsequently, multivariate Cox regression models were utilized to validate mortality predictions at 12, 24, and 36 months.
Results
Observed plasma cytokine levels before treatment were significantly lower for IL-1RA (
p
< 0.001) and MCP-1 (
p
< 0.05) when in the survivor group. Incorporating plasma levels of IL-1RA, IL-6, and high-risk CURB-65 score demonstrated the highest area under curve (AUC) value (0.96) for predicting 1-year mortality. For 1-, 2- and 3-year predictions, the single-factor model with IL-1RA demonstrated superior performance compared to all multiple-variate models (AUC = 0.95/0.78/0.78).
Conclusions
IL-1RA is a biomarker for predicting 3-year survival. Further investigations to explore the pathogenetic role of IL-1RA in HIV-associated disseminated cryptococcosis and as a potential therapeutic target are warranted.
Publisher
Springer Berlin Heidelberg,Springer Nature B.V
Subject
/ AIDS-Related Opportunistic Infections - microbiology
/ AIDS-Related Opportunistic Infections - mortality
/ Cryptococcosis - drug therapy
/ Female
/ HIV
/ HIV Infections - complications
/ Human immunodeficiency virus
/ Humans
/ Interleukin 1 receptor antagonist
/ Lung Diseases, Fungal - microbiology
/ Lung Diseases, Fungal - mortality
/ Lungs
/ Male
/ Medicine
/ Monocyte chemoattractant protein 1
/ Survival
