Unique characteristics of cryptococcosis identified after death in patients with liver cirrhosis: comparison with concurrent cohort diagnosed antemortem.
Characteristics of cirrhosis-associated cryptococcosis first diagnosed after death are not fully known. In a multicenter study, data generated as standard of care was systematically collected in 113 consecutive patients with cirrhosis and cryptococcosis followed for 80 patient-years. The diagnosis of cryptococcosis was first established after death in 15.9% (18/113) of the patients. Compared to cases diagnosed while alive, these patients had higher MELD score (33 vs. 22, P = .029) and higher rate of cryptococcemia (75.0% vs. 41.9%, P = .027). Cases diagnosed after death, in comparison to those diagnosed during life were more likely to present with shock (OR 3.42, 95% CI 1.18-9.90, P = .023), require mechanical ventilation at admission (OR 8.5, 95% CI 2.74-26.38, P = .001), less likely to undergo testing for serum cryptococcal antigen (OR 0.07, 95% CI 0.02-0.21, P < .001) and have positive antigen when the test was performed (OR 0.07, 95% CI 0.01-0.60, P = .016). In a subset of cirrhotic patients with advanced liver disease cryptococcosis was first recognized after death. These patients had the characteristics of presenting with fulminant fungemia, were less likely to have positive serum cryptococcal antigen and posed a diagnostic challenge for care providers.
University of Pittsburgh, Pittsburgh, PA.
Nina
N
Singh
University of Virginia, Charlottesville, VA.
Costi D
CD
Sifri
University of Pittsburgh, Pittsburgh, PA.
Fernanda P
FP
Silveira
University of Iowa, Iowa City, IA; Duke University Medical Center, Durham, NC.
Rachel
R
Miller
University of Michigan, Ann Arbor, MI.
Kevin S
KS
Gregg
Icahn School of Medicine at Mount Sinai, New York, NY.
Shirish
S
Huprikar
University of Washington, Seattle, WA.
Erika D
ED
Lease
Vanderbilt University, Nashville, TN.
Andrea
A
Zimmer
Vanderbilt University, Nashville, TN.
J Stephen
JS
Dummer
Baylor Health System, Dallas, TX.
Cedric W
CW
Spak
Cleveland Clinic, Cleveland, OH.
Christine
C
Koval
Yale School of Medicine, New Haven, CT; University of Connecticut School of Medicine, Farmington, CT.
David B
DB
Banach
University of Texas Southwestern Medical Center, Dallas, TX.
Miloni
M
Shroff
University of Texas Southwestern Medical Center, Dallas, TX.
Jade
J
Le
Johns Hopkins University, Baltimore, MD.
Darin
D
Ostrander
Johns Hopkins University, Baltimore, MD.
Robin
R
Avery
University of Kansas, Kansas City, KS.
Albert
A
Eid
Mayo Clinic, Rochester, MN.
Raymund R
RR
Razonable
University of South Florida, Tampa, FL.
Jose
J
Montero
University of Pennsylvania, Philadelphia, PA.
Emily
E
Blumberg
UCSF, Fresno Branch, San Francisco, CA.
Ahlaam
A
Alynbiawi
University of Miami, Miller School of Medicine, Miami, FL.
Michele I
MI
Morris
 St. Luke's Hospital, Kansas City, MO.
Henry B
HB
Randall
Henry Ford Hospital, Detroit, MI.
George
G
Alangaden
Virginia Commonwealth University, Richmond, VA.
Jeffrey
J
Tessier
University of Pittsburgh, Pittsburgh, PA.
Thomas V
TV
Cacciarelli
University of Pittsburgh, Pittsburgh, PA.
Marilyn M
MM
Wagener
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Hsin Yun
HY
Sun
D003453:Cryptococcosis / Q000473:pathology*; D005260:Female; D016469:Fungemia / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index