Length of hospital stay, in-patient mortality, and factors associated with mortality among HIV- associated cryptococcal meningitis patients at tertiary hospitals in Uganda

Abstract

Abstract Introduction: Cryptococcal meningitis (CM) remains the second most common and lethal opportunistic infection among People Living with HIV (PLWHIV) in sub-Saharan Africa. Currently, patients are managed on single high-dose liposomal amphotericin B and flucytosine. However, there is no sufficient data on whether the new treatment regimen has an effect on reducing inpatient mortality and length of hospital stay in the real-world setting. The study intended to investigate the proportion of inpatient mortality, length of hospital stay (LOS), and factors associated with mortality among patients of HIV-Cryptococcal meningitis. Methods: A cross-sectional study design, where a review of medical records of 173 patients admitted between December 2022 and May 2023 at 11 tertiary facilities was conducted. Medical records of HIV-CM pts were reviewed following the facility archive system and data was entered using the Kobo App. Univariate descriptive statistics were used to summarize the background characteristics. Modified Poisson regression was used to ascertain factors associated with mortality at bivariable and, multivariable associations were presented through adjusted prevalence ratios with their 95% confidence intervals. All the data analysis was conducted using STATA Corp 15. Study findings: Of the 173 patients’ medical records reviewed, the majority (58.4%), were males with a median age of 38 years (IQR= 30, 48) and over a half (55.5%) were married. Forty percent had altered mental status (GCS <15) on admission. The percentage of inpatient mortality was 35.8%, which significantly varied by health facility. The mean LOS was 8.2±6.7 days. Factors associated with mortality were Male sex [adjusted prevalence ratio (APR); 1.87, 95%CI (1.21-2.87)], p-value=0.005), admission with a convulsion [APR, 1.86, 95%CI (1.21-2.86), p value=0.005)], altered mental status [APR; 1.66, 95%CI (1.07-2.57), p-value=0.023], and comorbid condition [APR, 2.26 95%CI (1.44-3.53), p-value=0.006]. Therapeutic lumbar punctures were significantly associated with reduced mortality [APR; 0.47, 95%CI (0.29-0.73), p value=0.001]. Conclusion: Almost 4 of every 10 patients admitted with HIV-CM died, on average spending more than a week in the hospital. Male sex, admission with a convulsion, altered mental status, and comorbid conditions were independently associated with mortality. Therapeutic LPs significantly reduced inpatient mortality. Health workers should be trained and empowered with skills to perform LPs and as well, include HIV-CM awareness in the comprehensive package of care for people living with HIV.