title: Gender-specific contributing risk factors and outcome of female cryptococcal meningoencephalitis patients.
abstract: BACKGROUND
  Although male predominance was documented in previous studies on cryptococcal meningoencephalitis (CM), there has been no statistical study about female CM patients despite recently noticeable increase in female prevalence. In the current study, we aimed to investigate the independent gender-specific contributing risk factors for onset of CM and factors related to survival time in female patients by chosen statistical tools.
  
  
  METHODS
  There have been 108 patients diagnosed with CM from July 1, 1998 to June 30, 2013 in Nanfang Hospital that were included in our study. This 15-year retrospective study compared demographic and clinical features of 31 female patients with 77 males. Multivariate analysis was performed for detection of the contributors to the onset of CM in female patients. The independent variables for multivariate analysis were selected according to statistical significance in univariate analysis. Furthermore, Cox regression model was used to evaluate the factors related to survival length.
  
  
  RESULTS
  Use of corticosteroids or other immunosuppressants (32.3% versus 11.7%; p = 0.011) and history of systemic lupus erythematosus (SLE) and other autoimmune diseases (29% versus 3.9%; p < 0.001) were more common in females, but only the history of SLE or other autoimmune diseases was significant (OR 10.59, 95% CI 1.49-74.77, p = 0.02) by multivariate analysis. The ratio of cerebrospinal fluid (CSF) glucose-to-blood glucose was related to the survival time (p = 0.03, 95% CI 0-0.71).
  
  
  CONCLUSIONS
  The results showed that the history of SLE or other autoimmune diseases rather than chronic use of corticosteroids and/or immunosuppressants was the independent gender-specific contributing risk factor in female CM patients. Therefore, more attention should be made to the prevention of infection from the genus Cryptococcus spp. in female patients with SLE or other autoimmune diseases. In addition, decreased ratio of CSF glucose-to-blood glucose before antifungal therapy predicted the worse prognosis.
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China. gzzhenghui0527@gmail.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China. mingyuelimy@163.com.
authors.forename: Mingyue
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China. wangdm03@gmail.com.
authors.forename: Dongmei
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China. 573451413@qq.com.
authors.forename: Jia
authors.initials: J
authors.lastname: ling Yang
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China. joanabc333@126.com.
authors.forename: Qiong
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China. 2925611568@qq.com.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China. yangman80@163.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: Man
authors.affiliation: Medical Records Room, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China. loudspeaker28@163.com.
authors.forename: Junying
authors.initials: J
authors.lastname: Lao
authors.affiliation: Medical Records Room, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China. ningfen2008@163.com.
authors.forename: Ningfen
authors.initials: N
authors.lastname: Chen
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China. pansuyue82@qq.com.
authors.forename: Suyue
authors.initials: S
authors.lastname: Pan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008297:Male; D008590:Meningoencephalitis / Q000150:complications / Q000628:therapy*; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents