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...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2021-03-01
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| Series: | Therapeutic Advances in Infectious Disease |
| Online Access: | https://doi.org/10.1177/20499361211004367 |
| _version_ | 1818624084803584000 |
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| author | Solana Archuleta Amal A. Gharamti Stefan Sillau Paula Castellanos Sindhu Chadalawada William Mundo Mehdi Bandali Jose Oñate Ernesto Martínez Daniel B. Chastain Kristen DeSanto Leland Shapiro Ilan S. Schwartz Carlos Franco-Paredes Andrés F. Henao-Martínez |
| author_facet | Solana Archuleta Amal A. Gharamti Stefan Sillau Paula Castellanos Sindhu Chadalawada William Mundo Mehdi Bandali Jose Oñate Ernesto Martínez Daniel B. Chastain Kristen DeSanto Leland Shapiro Ilan S. Schwartz Carlos Franco-Paredes Andrés F. Henao-Martínez |
| author_sort | Solana Archuleta |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-16T18:51:20Z |
| format | Article |
| id | doaj.art-e814de8117da41dca92e0c9602f1dd8c |
| institution | Directory Open Access Journal |
| issn | 2049-937X |
| language | English |
| last_indexed | 2024-12-16T18:51:20Z |
| publishDate | 2021-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Infectious Disease |
| spelling | doaj.art-e814de8117da41dca92e0c9602f1dd8c2022-12-21T22:20:42ZengSAGE PublishingTherapeutic Advances in Infectious Disease2049-937X2021-03-01810.1177/20499361211004367Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort studySolana ArchuletaAmal A. GharamtiStefan SillauPaula CastellanosSindhu ChadalawadaWilliam MundoMehdi BandaliJose OñateErnesto MartínezDaniel B. ChastainKristen DeSantoLeland ShapiroIlan S. SchwartzCarlos Franco-ParedesAndrés F. Henao-MartínezBackground: 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.https://doi.org/10.1177/20499361211004367 |
| spellingShingle | Solana Archuleta Amal A. Gharamti Stefan Sillau Paula Castellanos Sindhu Chadalawada William Mundo Mehdi Bandali Jose Oñate Ernesto Martínez Daniel B. Chastain Kristen DeSanto Leland Shapiro Ilan S. Schwartz Carlos Franco-Paredes Andrés F. Henao-Martínez Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study Therapeutic Advances in Infectious Disease |
| 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 |
| url | https://doi.org/10.1177/20499361211004367 |
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