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Predictive Model for Permanent Shunting in Cryptococcal meningitis

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  • 1 Division of Neurosurgery, Department of Surgery, Khon Kaen University, Khon Kaen, Thailand;
  • | 2 Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand;
  • | 3 Research Center in Back, Neck Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand;
  • | 4 Non-communicable Diseases Research Group, Khon Kaen University, Khon Kaen, Thailand

Cryptococcal meningitis may have long-term morbidity and requires a permanent cerebrospinal fluid shunt. This study aimed to evaluate the risk factors and create a predictive model for permanent shunt treatment in cryptococcal meningitis patients. This was a retrospective analytical study conducted at Khon Kaen University. The study period was from January 2005 to December 2015. We enrolled all adult patients diagnosed with cryptococcal meningitis. Risk factors predictive for permanent shunting treatment were analyzed by multivariate logistic regression analysis. There were 341 patients diagnosed with cryptococcal meningitis. Of those, 64 patients (18.7%) were treated with permanent shunts. There were three independent factors associated with permanent shunt treatment. The presence of hydrocephalus had the highest adjusted odds ratio at 56.77. The resulting predictive model for permanent shunt treatment (y) is (−3.85) + (4.04 × hydrocephalus) + (2.13 × initial cerebrospinal fluid (CSF) opening pressure (OP) > 25 cm H2O) + (1.87 × non-human immune deficiency vrus (HIV)). In conclusion, non-HIV status, initial CSF OP greater than or equal to 25 cm H2O, and the presence of hydrocephalus are indicators of the future necessity for permanent shunt therapy.

Author Notes

Address correspondence to Amnat Kitkhuandee, Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Thailand 123 Mitraparp road, Khon Kaen 40002, Thailand. E-mail: amnaki@kku.ac.th

Authors’ addresses: Woralux Phusoongnern and Amnat Kitkhuandee, Khon Kaen University Faculty of Medicine, Surgery, Khon Kaen, Thailand, E-mails: woraluxgee@gmail.com and amnaki@kku.ac.th. Siriluck Anunnatsiri, Faculty of Medicine, Khon Kaen University, Medicine, Khon Kaen, Thailand, E-mail: asiril@kku.ac.th. Kittisak Sawanyawisuth, Khon Kaen University, Research Center in Back, Neck Other Joint Pain and Human performance (BNOJPH), Khon Kaen University Faculty of Medicine, Surgery, and Sleep Apnea Research Group, Khon Kaen University, Khon Kaen, Thailand, E-mail: kittisak@kku.ac.th.

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