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Short-term and long-term outcomes in patients with cryptococcal meningitis after ventriculoperitoneal shunt placement

OBJECTIVE: The purpose of this study was to assess the short-term and long-term outcomes of ventriculoperitoneal shunt (VPS) placement in patients with cryptococcal meningitis (CM). METHODS: We performed a retrospective analysis of all patients with CM admitted to the Peking Union Medical College Ho...

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Autores principales: Wen, Junxian, Yin, Rui, Chang, Jianbo, Chen, Yihao, Dong, Xiying, Cao, Wei, Ma, Xiaojun, Li, Taisheng, Wei, Junji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712185/
https://www.ncbi.nlm.nih.gov/pubmed/36468057
http://dx.doi.org/10.3389/fneur.2022.773334
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author Wen, Junxian
Yin, Rui
Chang, Jianbo
Chen, Yihao
Dong, Xiying
Cao, Wei
Ma, Xiaojun
Li, Taisheng
Wei, Junji
author_facet Wen, Junxian
Yin, Rui
Chang, Jianbo
Chen, Yihao
Dong, Xiying
Cao, Wei
Ma, Xiaojun
Li, Taisheng
Wei, Junji
author_sort Wen, Junxian
collection PubMed
description OBJECTIVE: The purpose of this study was to assess the short-term and long-term outcomes of ventriculoperitoneal shunt (VPS) placement in patients with cryptococcal meningitis (CM). METHODS: We performed a retrospective analysis of all patients with CM admitted to the Peking Union Medical College Hospital from September 1990 to January 2021. We collected related clinical features to analyze the short- and long-term outcomes of VPS at 1 month and 1 year at least the following therapy, respectively. Overall survival (OS) was compared with all patients and a subgroup of critically ill cases by the Kaplan–Meier method with the log-rank test. Univariable and multivariable analyses were also performed using the Cox proportional hazard model to identify statistically significant prognostic factors. RESULTS: We enrolled 98 patients, fifteen of whom underwent VPS. Those who received VPS had a lower cerebrospinal fluid (CSF) Cryptococcus burden (1:1 vs. 1:16; p = 0.046), lower opening pressures (173.3 mmH(2) O vs. 224 mmH(2)O; p = 0.009) at lumbar punctures, and a lower incidence of critical cases (6.7 vs. 31.3%; p = 0.049). According to our long-term follow-up, no significant difference was shown in the Barthel Index (BI) between the two groups. Two patients in the VPS group suffered postoperative complications and had to go through another revision surgery. According to survival analysis, overall survival (OS) between the VPS and non-VPS groups was not significantly different. However, the Kaplan–Meier plots showed that critical patients with VPS had better survival in OS (p < 0.009). Multivariable analyses for critical patients showed VPS was an independent prognostic factor. CONCLUSION: A VPS could reduce the intracranial pressure (ICP), decrease the counts of Cryptococcus neoformans by a faster rate and reduce the number of critical cases. The VPS used in critical patients with CM has a significant impact on survival, but it showed no improvement in the long-term Barthel Index (BI) vs. the conservative treatment and could lead to postoperative complications.
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spelling pubmed-97121852022-12-02 Short-term and long-term outcomes in patients with cryptococcal meningitis after ventriculoperitoneal shunt placement Wen, Junxian Yin, Rui Chang, Jianbo Chen, Yihao Dong, Xiying Cao, Wei Ma, Xiaojun Li, Taisheng Wei, Junji Front Neurol Neurology OBJECTIVE: The purpose of this study was to assess the short-term and long-term outcomes of ventriculoperitoneal shunt (VPS) placement in patients with cryptococcal meningitis (CM). METHODS: We performed a retrospective analysis of all patients with CM admitted to the Peking Union Medical College Hospital from September 1990 to January 2021. We collected related clinical features to analyze the short- and long-term outcomes of VPS at 1 month and 1 year at least the following therapy, respectively. Overall survival (OS) was compared with all patients and a subgroup of critically ill cases by the Kaplan–Meier method with the log-rank test. Univariable and multivariable analyses were also performed using the Cox proportional hazard model to identify statistically significant prognostic factors. RESULTS: We enrolled 98 patients, fifteen of whom underwent VPS. Those who received VPS had a lower cerebrospinal fluid (CSF) Cryptococcus burden (1:1 vs. 1:16; p = 0.046), lower opening pressures (173.3 mmH(2) O vs. 224 mmH(2)O; p = 0.009) at lumbar punctures, and a lower incidence of critical cases (6.7 vs. 31.3%; p = 0.049). According to our long-term follow-up, no significant difference was shown in the Barthel Index (BI) between the two groups. Two patients in the VPS group suffered postoperative complications and had to go through another revision surgery. According to survival analysis, overall survival (OS) between the VPS and non-VPS groups was not significantly different. However, the Kaplan–Meier plots showed that critical patients with VPS had better survival in OS (p < 0.009). Multivariable analyses for critical patients showed VPS was an independent prognostic factor. CONCLUSION: A VPS could reduce the intracranial pressure (ICP), decrease the counts of Cryptococcus neoformans by a faster rate and reduce the number of critical cases. The VPS used in critical patients with CM has a significant impact on survival, but it showed no improvement in the long-term Barthel Index (BI) vs. the conservative treatment and could lead to postoperative complications. Frontiers Media S.A. 2022-11-17 /pmc/articles/PMC9712185/ /pubmed/36468057 http://dx.doi.org/10.3389/fneur.2022.773334 Text en Copyright © 2022 Wen, Yin, Chang, Chen, Dong, Cao, Ma, Li and Wei. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Wen, Junxian
Yin, Rui
Chang, Jianbo
Chen, Yihao
Dong, Xiying
Cao, Wei
Ma, Xiaojun
Li, Taisheng
Wei, Junji
Short-term and long-term outcomes in patients with cryptococcal meningitis after ventriculoperitoneal shunt placement
title Short-term and long-term outcomes in patients with cryptococcal meningitis after ventriculoperitoneal shunt placement
title_full Short-term and long-term outcomes in patients with cryptococcal meningitis after ventriculoperitoneal shunt placement
title_fullStr Short-term and long-term outcomes in patients with cryptococcal meningitis after ventriculoperitoneal shunt placement
title_full_unstemmed Short-term and long-term outcomes in patients with cryptococcal meningitis after ventriculoperitoneal shunt placement
title_short Short-term and long-term outcomes in patients with cryptococcal meningitis after ventriculoperitoneal shunt placement
title_sort short-term and long-term outcomes in patients with cryptococcal meningitis after ventriculoperitoneal shunt placement
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9712185/
https://www.ncbi.nlm.nih.gov/pubmed/36468057
http://dx.doi.org/10.3389/fneur.2022.773334
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