Analysis of risk factors for dismal prognosis of cryptococcal meningitis and construction of a Nomogram predictive model

Abstract

Objective To analyze the risk factors for dismal prognosis in patients with cryptococcal meningitis and construct a prediction scoring system Nomogram model. Methods A total of 100 patients with cryptococcal meningitis who treated with anticryptococcal therapy admitted to Affiliated Hospital of Zunyi Medical University from January 2010 to August 2022 were selected. The patients were divided into favorable prognosis group (n = 19) and dismal prognosis group (n = 81) according to the results of cerebrospinal fluid (CSF) cryptococcal culture during hospitalization and clinical symptoms and signs at the time of discharge. Risk factors were screened by using univariate and multivariate stepwise Logistic regression analyses. A Nomogram model was constructed based on the risk factors, the receiver operating characteristic (ROC) curve and calibration curves of the model were plotted, and Hosmer - Lemeshow goodness-of-fit test was performed. Results The proportion of patients in the dismal prognosis group with Nutritional Risk Screening 2002 (NRS 2002) score (Z = - 3.898, P = 0.000), CSF pressure > 250 mm H2O (χ2 = 9.512，P = 0.002) and duration of antifungal treatment 250 mm H2O (OR = 0.108, 95%CI: 0.018-0.659; P = 0.016), and the duration of antifungal treatment 250 mm H2O, and antifungal treatment < 14 d had a dismal prognosis, and the Nomogram model constructed accordingly has a high predictive value of dismal prognostic risk.

Keywords

• meningitis, cryptococcal
• amphotericin b
• prognosis
• risk factors
• logistic models
• nomograms