Presentation and prognosis of cryptococcosis requiring intensive care unit admission in France: the CRYPTO-ICU study - PubMed

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Cryptococcosis is a life-threatening opportunistic infection primarily affecting immunocompromised hosts.
The CRYPTO-ICU study analyzed 151 patients admitted to French ICUs for severe cryptococcosis between 2000 and 2022.
56.9% of patients were HIV-positive, but cases in non-HIV patients increased over time (51.3% in 2012-2022 vs. 32.4% before 2012).
82.5% of patients were on immunosuppressive therapy.
Central nervous system infection was the most common (91.1%), followed by lung infection (39.7%).
59.8% had fungemia, and 75.2% had disseminated infection.
Neurological failure was the leading organ impairment (75.5%), followed by respiratory failure (47.7%), acute kidney injury (41.7%), and shock (24.5%).
Median SOFA score was 4 [2-7].
54.9% required invasive mechanical ventilation, 34.4% needed vasopressors, and 18.5% required renal replacement therapy.
90-day mortality was 49.6%, with higher mortality in patients requiring mechanical ventilation and vasopressors (94%).
Independent predictors of mortality included higher SOFA score, admission between 2000-2012, disseminated infection, and delayed antifungal therapy.
HIV status did not significantly affect mortality.
Early diagnosis and treatment are crucial for improving prognosis.

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