AAIT: A novel prognostic model for HIV-negative patients with cryptococcal meningoencephalitis New Scoring Model for Non-HIV Patients with CM

Qun Cai; Hao Wang; Sihan Ruan; Mingyan Zhu; Jinnan Duan; Shanshan Sun; Jifang Sheng

doi:10.1093/mmy/myaa095

AAIT: A novel prognostic model for HIV-negative patients with cryptococcal meningoencephalitis New Scoring Model for Non-HIV Patients with CM

Med Mycol. 2020 Dec 10:myaa095. doi: 10.1093/mmy/myaa095. Online ahead of print.

Authors

Qun Cai¹, Hao Wang¹, Sihan Ruan², Mingyan Zhu³, Jinnan Duan¹, Shanshan Sun¹, Jifang Sheng¹

Affiliations

¹ Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Rd, Shangcheng District, Hangzhou, 310003, China.
² Taizhou Central Hospital (Taizhou University Hospital), 999 donghai avenue, jiaojiang district, taizhou city, zhejiang province, China.
³ Department of Infectious Disease, The Affiliated Chaohu Hospital of Anhui Medical University, Chaohu, Hefei, 238000, China.

PMID: 33305321
DOI: 10.1093/mmy/myaa095

Abstract

Cryptococcal meningitis (CM) is a common opportunistic infection in HIV-negative patients, with mortality rates as high as those in the HIV-negative population. This requires accurate initial clinical decision-making, warranting the development of a prognostic score. Two groups of patients were investigated separately to develop a novel prognostic model (AAIT) for HIV-negative patients with CM. A retrospective analysis of 201 HIV-negative patients with CM was conducted to develop the CM prognostic score. In addition, the CM cohort (n = 21) was recruited longitudinally to verify the new prognostic score. Meanwhile, the association between the prognostic score and 1-year mortality of CM was expounded. AAIT (age, albumin, combined bacterial infection, and total triiodothyronine) is a novel prognostic score based on age, albumin level, combined bacterial infection, and total triiodothyronine (TT3) level, which were significantly higher in nonsurvivors than in survivors (0.68 [-0.70 to 1.55] vs - 1.72 [-3.75 to -0.73], P < .00). Regarding the AAIT-predicted 1-year mortality, the area under the receiver operating characteristic curve (AUROC) value was 0.857, whereas it was 0.965 for the validation cohort. In the induction period, different treatment options did not seem to significantly improve the 1-year survival rate. AAIT is a straightforward and clear prognostic score that can add value to predict the outcomes in HIV-negative patients with CM. In addition, controlling infection and increasing the albumin and TT3 levels may help improve clinical outcomes in HIV-negative patients with CM.

Lay abstract: AAIT (age, albumin, combined bacterial infection, and total triiodothyronine) is a straightforward and clear prognostic score that can add value to predict the outcomes HIV-negative patients with CM.

Keywords: Cryptococcal meningitis; HIV-negative patients; prognosis; therapy.