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RISK FACTORS FOR DEATH IN ACQUIRED IMMUNODEFICIENCY SYNDROME–ASSOCIATED DISSEMINATED HISTOPLASMOSIS

We performed a retrospective study of 164 human immunodeficiency virus (HIV)–infected patients with disseminated histoplasmosis to identify the risk factors for death. Death occurred in 32% of the cases. Univariate analysis identified the following risk factors: diarrhea (odds ratio [OR] = 3.9, P = 0.001), neurologic manifestations (OR = 5.8, ; P = 0.001), hemoglobin level < 8.0g/dL (OR = 2.7, P = 0.004), urea level 2 times the normal upper limit (OR = 5.0, P < 0.001), creatinine level > 1.5 mg/dL (OR = 2.9, P = 0.005), aspartate aminotransferase (AST) level > 2.5 times the normal upper limit (OR = 3.1, P = 0.01), respiratory insufficiency (OR = 9.7, P < 0.001), sepsis (OR = 20.2, P < 0.001), and acute renal failure (OR = 2.5, P = 0.011). A hemoglobin level < 8.0 g/dL (OR = 3.8, P = 0.008), an AST level 2.5 times the normal limit (OR = 1.0, P = 0.007), acute renal failure (OR = 2.96, P = 0.015), and respiratory insufficiency (OR = 12.2, P = 0.01) were independent risk factors for death.

Received September 21, 2005. Accepted for publication October 15, 2005.

Acknowledgments: We are very grateful to the physicians, residents, medical students, and nurses from the Hospital São José de Doenças Infecciosas for assistance provided to the patients and technical support.

Financial support: This research was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq, Brazil. Geraldo Bezerra da Silva Júnior and Marúsia Thomaz Ferreira were supported by a grant from CNPq.

^* Address correspondence to Geraldo Bezerra da Silva Ju' nior, Rua 25 de Marco, 997, Fortaleza, CE, Brazil CEP 60060-120. E-mail: geraldobezerrajr{at}yahoo.com.br or efdaher{at}for.terra.com.br

Authors’ addresses: Elizabeth de Francesco Daher, Fernando Antonio de Sousa Barros, Geraldo Bezerra da Silva Júnior, Marúsia Thomaz Ferreira, Julieta Cunha Martins, Soraya Alves Jacinto Oliveira, and Oswaldo Augusto Gutiérrez-Adrianzén, Department of Internal Medicine, Faculdade de Medicina, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil, E-mails: efdaher{at}for.terra.com.br and geraldobezerrajr{at}yahoo.com.br. Christianne Fernandes Valente Takeda, Hospital São José de Doenças Infecciosas. Fortaleza, Ceará, Brazil. Rosa Maria Salani Mota, Department of Statistics, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.

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