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Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study
BACKGROUND: Diabetes mellitus is an established risk factor for bacterial infections, but its role in cryptococcosis is unclear. The study aimed to determine whether uncontrolled diabetes (HbA1c >7%) was an independent risk factor for mortality in cryptococcosis. METHODS: A retrospective case–con...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992770/ https://www.ncbi.nlm.nih.gov/pubmed/33815790 http://dx.doi.org/10.1177/20499361211004367 |
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author | Archuleta, Solana Gharamti, Amal A. Sillau, Stefan Castellanos, Paula Chadalawada, Sindhu Mundo, William Bandali, Mehdi Oñate, Jose Martínez, Ernesto Chastain, Daniel B. DeSanto, Kristen Shapiro, Leland Schwartz, Ilan S. Franco-Paredes, Carlos Henao-Martínez, Andrés F. |
author_facet | Archuleta, Solana Gharamti, Amal A. Sillau, Stefan Castellanos, Paula Chadalawada, Sindhu Mundo, William Bandali, Mehdi Oñate, Jose Martínez, Ernesto Chastain, Daniel B. DeSanto, Kristen Shapiro, Leland Schwartz, Ilan S. Franco-Paredes, Carlos Henao-Martínez, Andrés F. |
author_sort | Archuleta, Solana |
collection | PubMed |
description | BACKGROUND: Diabetes mellitus is an established risk factor for bacterial infections, but its role in cryptococcosis is unclear. The study aimed to determine whether uncontrolled diabetes (HbA1c >7%) was an independent risk factor for mortality in cryptococcosis. METHODS: A retrospective case–control study partially matched by age and gender was performed in patients tested for Cryptococcus infection at the University of Colorado Hospital from 2000 to 2019. A multivariable logistic regression model was used to identify mortality predictors. Cox proportional hazard model was used for survival analysis. RESULTS: We identified 96 cases of cryptococcosis and 125 controls. Among cases, cryptococcal meningitis (49.0%) and pneumonia (36.5%) constituted most infections. Cases with pulmonary cryptococcosis with uncontrolled diabetes had a higher mortality at 10 weeks (50% versus 7%, p = 0.006) and 1 year (66.7% versus 13.8%, p = 0.005) compared to pulmonary cases with controlled or no diabetes. Unadjusted Cox proportional hazard model found an increased rate of death for uncontrolled diabetes at 10 weeks [hazard ratio 8.4, confidence interval (CI): 1.4–50.8, p = 0.02] and 1 year (hazard ratio 7.0, CI: 1.7–28.4, p = 0.007) among pulmonary cryptococcosis cases. Multivariable analysis showed a significantly increased odds of 10 weeks [odds ratio (OR) = 4.3, CI: 1.1–16.5, p = 0.035] and 1 year (OR = 5.0, CI: 1.4–18.3, p = 0.014) mortality for uncontrolled diabetes among pulmonary cryptococcosis cases. After adjustment for gender, age, and case/control, for every 1% increase in HbA1c levels, the odds of pulmonary cryptococcosis mortality at 1 year increased by 11% (OR = 1.6, CI 95%: 1.1–2.3, p = 0.006). CONCLUSION: Uncontrolled diabetes is associated with worse outcomes in pulmonary cryptococcosis, including a 4-fold and 6-fold increased odds of death at 10 weeks and 1 year, respectively. Glucose control interventions should be explored to improve clinical outcomes in patients with pulmonary cryptococcosis. |
format | Online Article Text |
id | pubmed-7992770 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-79927702021-04-02 Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study Archuleta, Solana Gharamti, Amal A. Sillau, Stefan Castellanos, Paula Chadalawada, Sindhu Mundo, William Bandali, Mehdi Oñate, Jose Martínez, Ernesto Chastain, Daniel B. DeSanto, Kristen Shapiro, Leland Schwartz, Ilan S. Franco-Paredes, Carlos Henao-Martínez, Andrés F. Ther Adv Infect Dis Original Research BACKGROUND: Diabetes mellitus is an established risk factor for bacterial infections, but its role in cryptococcosis is unclear. The study aimed to determine whether uncontrolled diabetes (HbA1c >7%) was an independent risk factor for mortality in cryptococcosis. METHODS: A retrospective case–control study partially matched by age and gender was performed in patients tested for Cryptococcus infection at the University of Colorado Hospital from 2000 to 2019. A multivariable logistic regression model was used to identify mortality predictors. Cox proportional hazard model was used for survival analysis. RESULTS: We identified 96 cases of cryptococcosis and 125 controls. Among cases, cryptococcal meningitis (49.0%) and pneumonia (36.5%) constituted most infections. Cases with pulmonary cryptococcosis with uncontrolled diabetes had a higher mortality at 10 weeks (50% versus 7%, p = 0.006) and 1 year (66.7% versus 13.8%, p = 0.005) compared to pulmonary cases with controlled or no diabetes. Unadjusted Cox proportional hazard model found an increased rate of death for uncontrolled diabetes at 10 weeks [hazard ratio 8.4, confidence interval (CI): 1.4–50.8, p = 0.02] and 1 year (hazard ratio 7.0, CI: 1.7–28.4, p = 0.007) among pulmonary cryptococcosis cases. Multivariable analysis showed a significantly increased odds of 10 weeks [odds ratio (OR) = 4.3, CI: 1.1–16.5, p = 0.035] and 1 year (OR = 5.0, CI: 1.4–18.3, p = 0.014) mortality for uncontrolled diabetes among pulmonary cryptococcosis cases. After adjustment for gender, age, and case/control, for every 1% increase in HbA1c levels, the odds of pulmonary cryptococcosis mortality at 1 year increased by 11% (OR = 1.6, CI 95%: 1.1–2.3, p = 0.006). CONCLUSION: Uncontrolled diabetes is associated with worse outcomes in pulmonary cryptococcosis, including a 4-fold and 6-fold increased odds of death at 10 weeks and 1 year, respectively. Glucose control interventions should be explored to improve clinical outcomes in patients with pulmonary cryptococcosis. SAGE Publications 2021-03-23 /pmc/articles/PMC7992770/ /pubmed/33815790 http://dx.doi.org/10.1177/20499361211004367 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Archuleta, Solana Gharamti, Amal A. Sillau, Stefan Castellanos, Paula Chadalawada, Sindhu Mundo, William Bandali, Mehdi Oñate, Jose Martínez, Ernesto Chastain, Daniel B. DeSanto, Kristen Shapiro, Leland Schwartz, Ilan S. Franco-Paredes, Carlos Henao-Martínez, Andrés F. Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study |
title | Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study |
title_full | Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study |
title_fullStr | Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study |
title_full_unstemmed | Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study |
title_short | Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study |
title_sort | increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single us cohort study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992770/ https://www.ncbi.nlm.nih.gov/pubmed/33815790 http://dx.doi.org/10.1177/20499361211004367 |
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