![]() ![]() Of these patients, 36 (23.8%) underwent VPS placement (the VPS group), and 115 (76.2%) did not undergo VPS placement (the non-VPS group). In this study, we compared the demographic characteristics, symptoms, and CSF chemical profiles between HCM patients who underwent VPS placement and HCM patients who did not undergo VPS placement.īetween January 2011 and December 2019, 151 HCM patients from the First Affiliated Hospital of Zhejiang University were eligible for this retrospective cohort study. To further study the safety and efficacy of VPS placement in HCM patients and evaluate the effects of VPS placement on the CSF biochemical profiles of HCM patients, we conducted this study. VPS is more reliable and stable than lumber puncture and can maintain long-term shunt effects. In addition, VPS placement could decrease the excess volume of cerebrospinal fluid (CSF) and the fungal polysaccharide load in the ventricles. Meanwhile, other studies have demonstrated that VPS placement can rapidly relieve symptoms and improve the prognosis of HICP patients with rare postoperative infections. Some studies have indicated that VPS placement in immunosuppressed patients may lead to shunt infection, blockage of the shunt device owing to the high fungal load, and peritoneal Cryptococcus seeding by draining Cryptococcus into the abdominal cavity. However, the placement of VPSs in HIV-infected patients is debatable. ĭaily lumbar puncture and the placement of ventriculoperitoneal shunts (VPSs) are important management strategies for HICP patients. ![]() Thus, HICP control is a critical determinant of HCM patient mortality. Importantly, high intracranial pressure (HICP) can occur in approximately 50% of patients, leading to increased mortality in patients with HCM. HIV-infected patients are susceptible to Cryptococcus, and cryptococcal meningitis is a life-threatening central nervous system infectious disease caused by Cryptococcus. Physicians should be aware of these changes in the CSF profiles of patients with HCM undergoing VPS. However, VPS significantly altered the CSF profiles, which could lead to misdiagnosis of tuberculous meningitis and some of them were diagnosed with immune reconstitution inflammatory syndrome. VPS decreased the intracranial pressure, improved neuroimaging radiology and reduced the 24-week mortality in HCM patients. In the multivariate analysis, we found that VPS placement was an independent risk factor for increased CSF protein (odds ratio : 27.8, 95% confidence interval 2.2–348.7 P = 0.010). Notably, the CSF protein levels were higher in the VPS group than in the non-VPS group at each examination time, and the CSF glucose was lower in the VPS group than in the non-VPS group even at the 12-week follow-up. Furthermore, the 24-week cumulative survival rates were also significantly higher in the VPS group (96.6% vs. 200.0 P = 0.025), and the rate of neuroimaging improvement was significantly higher in the VPS group (16/17 vs. ResultsĪfter 24 weeks of treatment, the intracranial pressure was significantly lower in the VPS group than in the non-VPS group (mmH 2O 155.0 vs. ![]() Univariate and multivariate logistic regression analyses were performed to identify the risk factors for increased CSF protein levels. The Kaplan–Meier method was used to analyze the survival rate. Demographic characteristics, symptoms, CSF biochemical profiles, and adverse events were compared between the two groups. ![]() Twenty-nine HCM patients who underwent ventriculoperitoneal shunt (the VPS group) and 57 HCM patients who did not undergo ventriculoperitoneal shunt (the non-VPS group) were enrolled in this propensity score matching analysis. The impact of ventriculoperitoneal shunt on cerebrospinal fluid (CSF) biochemical profiles in HIV-associated cryptococcal meningitis (HCM) patients remains unclear. ![]()
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