Risk Factors for Mortality among HIV-Infected Patients with Disseminated Histoplasmosis
Identifying prognostic factors is important in order to guide the choice of first-line therapy for disseminated histoplasmosis. Our objective was to identify factors associated with death among a cohort of 330 patients compiled over 34 years of clinical practice in French Guiana. Survival analysis w...
Main Authors: | , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
MDPI AG
2020-11-01
|
Series: | Journal of Fungi |
Subjects: | |
Online Access: | https://www.mdpi.com/2309-608X/6/4/326 |
_version_ | 1797546154262528000 |
---|---|
author | Mathieu Nacher Kinan Drak Alsibai Audrey Valdes Romain Blaizot Philippe Abboud Magalie Demar Félix Djossou Loïc Epelboin Caroline Misslin Balthazar Ntab Antoine Adenis Pierre Couppié |
author_facet | Mathieu Nacher Kinan Drak Alsibai Audrey Valdes Romain Blaizot Philippe Abboud Magalie Demar Félix Djossou Loïc Epelboin Caroline Misslin Balthazar Ntab Antoine Adenis Pierre Couppié |
author_sort | Mathieu Nacher |
collection | DOAJ |
description | Identifying prognostic factors is important in order to guide the choice of first-line therapy for disseminated histoplasmosis. Our objective was to identify factors associated with death among a cohort of 330 patients compiled over 34 years of clinical practice in French Guiana. Survival analysis was performed with death as the failure event and date of symptom onset as the origin event. Incidence rates were and Cox proportional hazards models were computed. Overall, 330 HIV-infected patients with disseminated histoplasmosis were included in the analysis, with 126 deaths occurring. One-quarter of all patients died within 6 months of the first symptoms. Patients with dyspnea, renal failure, arterial blood pressure < 90 mmHG, and a WHO performance score > 2 had a greater incidence of death. Bivariate analyses showed that patients with increased LDH, low hemoglobin, low serum protein, low CD4 counts, and low platelets tended to have a greater incidence of death. After adjusting for potential confounders, patients with dyspnea, a WHO performance score > 2, serum protein < 60 g/L, and hemoglobin < 8.9 g/dL had an increased risk of dying. The interaction terms showed that patients treated with liposomal amphotericin B had a marked reduction in death among patients with renal failure; among renal failure patients, the elevation of LDH was associated with a significant risk of death. |
first_indexed | 2024-03-10T14:25:04Z |
format | Article |
id | doaj.art-387562a1cce642bcb0be2e21afe7cb30 |
institution | Directory Open Access Journal |
issn | 2309-608X |
language | English |
last_indexed | 2024-03-10T14:25:04Z |
publishDate | 2020-11-01 |
publisher | MDPI AG |
record_format | Article |
series | Journal of Fungi |
spelling | doaj.art-387562a1cce642bcb0be2e21afe7cb302023-11-20T23:00:52ZengMDPI AGJournal of Fungi2309-608X2020-11-016432610.3390/jof6040326Risk Factors for Mortality among HIV-Infected Patients with Disseminated HistoplasmosisMathieu Nacher0Kinan Drak Alsibai1Audrey Valdes2Romain Blaizot3Philippe Abboud4Magalie Demar5Félix Djossou6Loïc Epelboin7Caroline Misslin8Balthazar Ntab9Antoine Adenis10Pierre Couppié11CIC INSERM 1424, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, FranceDepartment of Pathology, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, FranceEquipe Opérationnelle d’hygiène hospitalière, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, FranceDFR Santé, Université de Guyane, 97300 Cayenne, FranceService des Maladies Infectieuses et Tropicales, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, FranceLaboratory, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, FranceService des Maladies Infectieuses et Tropicales, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, FranceService des Maladies Infectieuses et Tropicales, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, FranceService de Médecine, Centre Hospitalier de l’Ouest Guyanais, 97320 Saint Laurent du Maroni, FranceDépartement d’Information Médicale, Centre Hospitalier de l’Ouest Guyanais, 97320 Saint Laurent du Maroni, FranceCIC INSERM 1424, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, FranceDFR Santé, Université de Guyane, 97300 Cayenne, FranceIdentifying prognostic factors is important in order to guide the choice of first-line therapy for disseminated histoplasmosis. Our objective was to identify factors associated with death among a cohort of 330 patients compiled over 34 years of clinical practice in French Guiana. Survival analysis was performed with death as the failure event and date of symptom onset as the origin event. Incidence rates were and Cox proportional hazards models were computed. Overall, 330 HIV-infected patients with disseminated histoplasmosis were included in the analysis, with 126 deaths occurring. One-quarter of all patients died within 6 months of the first symptoms. Patients with dyspnea, renal failure, arterial blood pressure < 90 mmHG, and a WHO performance score > 2 had a greater incidence of death. Bivariate analyses showed that patients with increased LDH, low hemoglobin, low serum protein, low CD4 counts, and low platelets tended to have a greater incidence of death. After adjusting for potential confounders, patients with dyspnea, a WHO performance score > 2, serum protein < 60 g/L, and hemoglobin < 8.9 g/dL had an increased risk of dying. The interaction terms showed that patients treated with liposomal amphotericin B had a marked reduction in death among patients with renal failure; among renal failure patients, the elevation of LDH was associated with a significant risk of death.https://www.mdpi.com/2309-608X/6/4/326disseminated histoplasmosisHIVmortalityrisk factorsliposomal amphotericin BFrench Guiana |
spellingShingle | Mathieu Nacher Kinan Drak Alsibai Audrey Valdes Romain Blaizot Philippe Abboud Magalie Demar Félix Djossou Loïc Epelboin Caroline Misslin Balthazar Ntab Antoine Adenis Pierre Couppié Risk Factors for Mortality among HIV-Infected Patients with Disseminated Histoplasmosis Journal of Fungi disseminated histoplasmosis HIV mortality risk factors liposomal amphotericin B French Guiana |
title | Risk Factors for Mortality among HIV-Infected Patients with Disseminated Histoplasmosis |
title_full | Risk Factors for Mortality among HIV-Infected Patients with Disseminated Histoplasmosis |
title_fullStr | Risk Factors for Mortality among HIV-Infected Patients with Disseminated Histoplasmosis |
title_full_unstemmed | Risk Factors for Mortality among HIV-Infected Patients with Disseminated Histoplasmosis |
title_short | Risk Factors for Mortality among HIV-Infected Patients with Disseminated Histoplasmosis |
title_sort | risk factors for mortality among hiv infected patients with disseminated histoplasmosis |
topic | disseminated histoplasmosis HIV mortality risk factors liposomal amphotericin B French Guiana |
url | https://www.mdpi.com/2309-608X/6/4/326 |
work_keys_str_mv | AT mathieunacher riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis AT kinandrakalsibai riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis AT audreyvaldes riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis AT romainblaizot riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis AT philippeabboud riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis AT magaliedemar riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis AT felixdjossou riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis AT loicepelboin riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis AT carolinemisslin riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis AT balthazarntab riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis AT antoineadenis riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis AT pierrecouppie riskfactorsformortalityamonghivinfectedpatientswithdisseminatedhistoplasmosis |