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Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis

BACKGROUND: Pulmonary cryptococcosis is an uncommon infectious disease that can develop in both immunocompromised and immunocompetent patients. The severity of chronic kidney disease (CKD) was reported to be one of the risk factors for pulmonary cryptococcosis, but its clinical characteristics have...

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Autores principales: Tashiro, Hiroki, Haraguchi, Tetsuro, Takahashi, Koichiro, Sadamatsu, Hironori, Tajiri, Ryo, Takamori, Ayako, Kimura, Shinya, Sueoka-Aragane, Naoko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191728/
https://www.ncbi.nlm.nih.gov/pubmed/32349734
http://dx.doi.org/10.1186/s12890-020-1149-3
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author Tashiro, Hiroki
Haraguchi, Tetsuro
Takahashi, Koichiro
Sadamatsu, Hironori
Tajiri, Ryo
Takamori, Ayako
Kimura, Shinya
Sueoka-Aragane, Naoko
author_facet Tashiro, Hiroki
Haraguchi, Tetsuro
Takahashi, Koichiro
Sadamatsu, Hironori
Tajiri, Ryo
Takamori, Ayako
Kimura, Shinya
Sueoka-Aragane, Naoko
author_sort Tashiro, Hiroki
collection PubMed
description BACKGROUND: Pulmonary cryptococcosis is an uncommon infectious disease that can develop in both immunocompromised and immunocompetent patients. The severity of chronic kidney disease (CKD) was reported to be one of the risk factors for pulmonary cryptococcosis, but its clinical characteristics have not been fully assessed. The purpose of this study was to clarify the clinical characteristics of advanced CKD in patients with pulmonary cryptococcosis. METHODS: The present study retrospectively investigated 56 patients who had non-human immunodeficiency virus (HIV) pulmonary cryptococcosis and were treated at Saga University Hospital between 2005 and 2018. The clinical characteristics were evaluated and compared between patients with estimated glomerular filtration rate (eGFR) > 45 mL/min/1.73 m(2) (n = 42, early CKD) and those with eGFR < 45 mL/min/1.73 m(2) (n = 14, advanced CKD. RESULTS: Compared with patients with early CKD, those with advanced CKD had significantly higher rate of disseminated cryptococcosis (21.4% vs. 2.4%, p = 0.03); lower percentage of patients who recovered after treatment (63.6% vs. 92.5%, p = 0.02); and more frequent clinical features of fever (57.1% vs. 19.0%, p < 0.01), pleural effusion (21.4% vs. 2.4%, p = 0.03), high white blood cell count (8550/mL vs. 6150/mL, p = 0.01) and C-reactive protein (CRP) (2.1 mg/dL vs. 0.2 mg/dL, p = 0.02), and low level of serum albumin (3.0 g/dL vs. 3.8 g/dL, p < 0.01). Multivariate analysis adjusted by immunosuppressive drug use indicated the significant factors of fever (odds ratio or β value [95% confidence interval] 6.4 [1.65–20.09], p < 0.01), high white blood cell count (1293.2 [110.2–2476.2], p = 0.03), C-reactive protein (0.89 [0.18–1.59], p = 0.01) and low level of serum albumin (− 0.34 [− 0.54 – − 0.14], p < 0.01) in patients with eGFR < 45 mL/min/1.73m(2). CONCLUSION: Advanced CKD was associated with poor clinical characteristics and outcomes in patients with non-HIV pulmonary cryptococcosis. TRIAL REGISTRATION: The patients in this study were registered retrospectively.
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spelling pubmed-71917282020-05-04 Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis Tashiro, Hiroki Haraguchi, Tetsuro Takahashi, Koichiro Sadamatsu, Hironori Tajiri, Ryo Takamori, Ayako Kimura, Shinya Sueoka-Aragane, Naoko BMC Pulm Med Research Article BACKGROUND: Pulmonary cryptococcosis is an uncommon infectious disease that can develop in both immunocompromised and immunocompetent patients. The severity of chronic kidney disease (CKD) was reported to be one of the risk factors for pulmonary cryptococcosis, but its clinical characteristics have not been fully assessed. The purpose of this study was to clarify the clinical characteristics of advanced CKD in patients with pulmonary cryptococcosis. METHODS: The present study retrospectively investigated 56 patients who had non-human immunodeficiency virus (HIV) pulmonary cryptococcosis and were treated at Saga University Hospital between 2005 and 2018. The clinical characteristics were evaluated and compared between patients with estimated glomerular filtration rate (eGFR) > 45 mL/min/1.73 m(2) (n = 42, early CKD) and those with eGFR < 45 mL/min/1.73 m(2) (n = 14, advanced CKD. RESULTS: Compared with patients with early CKD, those with advanced CKD had significantly higher rate of disseminated cryptococcosis (21.4% vs. 2.4%, p = 0.03); lower percentage of patients who recovered after treatment (63.6% vs. 92.5%, p = 0.02); and more frequent clinical features of fever (57.1% vs. 19.0%, p < 0.01), pleural effusion (21.4% vs. 2.4%, p = 0.03), high white blood cell count (8550/mL vs. 6150/mL, p = 0.01) and C-reactive protein (CRP) (2.1 mg/dL vs. 0.2 mg/dL, p = 0.02), and low level of serum albumin (3.0 g/dL vs. 3.8 g/dL, p < 0.01). Multivariate analysis adjusted by immunosuppressive drug use indicated the significant factors of fever (odds ratio or β value [95% confidence interval] 6.4 [1.65–20.09], p < 0.01), high white blood cell count (1293.2 [110.2–2476.2], p = 0.03), C-reactive protein (0.89 [0.18–1.59], p = 0.01) and low level of serum albumin (− 0.34 [− 0.54 – − 0.14], p < 0.01) in patients with eGFR < 45 mL/min/1.73m(2). CONCLUSION: Advanced CKD was associated with poor clinical characteristics and outcomes in patients with non-HIV pulmonary cryptococcosis. TRIAL REGISTRATION: The patients in this study were registered retrospectively. BioMed Central 2020-04-29 /pmc/articles/PMC7191728/ /pubmed/32349734 http://dx.doi.org/10.1186/s12890-020-1149-3 Text en © The Author(s). 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Tashiro, Hiroki
Haraguchi, Tetsuro
Takahashi, Koichiro
Sadamatsu, Hironori
Tajiri, Ryo
Takamori, Ayako
Kimura, Shinya
Sueoka-Aragane, Naoko
Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis
title Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis
title_full Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis
title_fullStr Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis
title_full_unstemmed Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis
title_short Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis
title_sort clinical impact of advanced chronic kidney disease in patients with non-hiv pulmonary cryptococcosis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191728/
https://www.ncbi.nlm.nih.gov/pubmed/32349734
http://dx.doi.org/10.1186/s12890-020-1149-3
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