Background
Cryptococcal meningitis (CM) remains the second most lethal opportunistic infection among People Living with HIV in sub-Saharan Africa. CM is managed on single high-dose liposomal amphotericin B and flucytosine. However, there is no sufficient data on whether the new treatment regimen has an effect on reducing inpatient mortality and length of hospital stay in the real-world setting. We aimed to investigate the proportion of inpatient mortality, length of hospital stay (LOS), and factors associated with mortality among patients with HIV-associated CM receiving liposomal amphotericin B-flucytosine regimen.
Methods
This was a cross-sectional study conducted to review medical records of patients admitted between December 2022 and May 2023 at 11 tertiary hospitals in Uganda. Medical records of 173 HIV-CM patients were reviewed. Univariate descriptive statistics were used to summarize the background characteristics. Modified Poisson regression was used to ascertain factors associated with mortality at bivariable and multivariable levels. Associations were presented through adjusted prevalence ratios with their 95% confidence intervals. Data were analyzed using STATA v15.
Results
Of the 173 patients’ medical records reviewed, the majority (58.4%), were males with a median age of 38 years (IQR= 30, 48) and over half (55.5%) were married. Forty percent of the patients had altered mental status (GCS<15) on admission. Overall, inpatient mortality for liposomal amphotericin B was 35.8% (compared to 42% of amphotericin B deoxycholate) and this significantly varied by health facility (range 7.1-100%). The median LOS was 7 days (IQR = 3, 12). Factors associated with mortality were male sex [adjusted prevalence ratio (APR); 1.87, 95%CI (1.21-2.87)], p-value=0.005), admission with a convulsion [APR, 1.86, 95%CI (1.21-2.86), p-value=0.005)], altered mental status [APR; 1.66, 95%CI (1.07-2.57), p-value=0.023], and presence of a comorbid condition [APR, 2.26 95%CI (1.44-3.53), p-value=0.006]. Therapeutic lumbar punctures were significantly associated with reduced mortality [APR; 0.47, 95%CI (0.29-0.73), p-value=0.001].
Conclusions
Liposomal amphotericin B regimen has lower mortality in the real-world setting. Patients on average spend more than a week in hospital. Male sex, admission with a convulsion, altered mental status, and comorbid conditions were independently associated with mortality. Therapeutic LPs significantly reduced inpatient mortality.
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