Efficacy and prognostic factor of ventricul-operitoneal shunt in the treatment of cryptococcal meningitis with intracranial hypertension

Abstract

Abstract Background: Cryptococcal meningitis (CM) combined with intracranial hypertension is associated with a poor prognosis. This study aimed to investigate the therapeutic efficacy and prognostic factor of ventriculo-peritoneal(V-P) shunt in the non-human immunodeficiency virus (HIV) CM patients withintracranial hypertension. Methods: A total of 136non-HIV CM patients with intracranial hypertension treated in our hospital from July 2010 to December 2019 wereretrospectively included. Fifty-seven patients underwent V-P shunt placement (the Shunt group) and 79 patients received conservative therapy (the conservative group). The clinical symptoms after treatment, the cerebrospinal fluid (CSF) tests results andtherapeutic outcomes were compared between the groups. Results: V-P shunt significantly reduced the incidences of headache, vomiting, cranial nerve injury, the intracranial pressure, and CSF leukocyte level in CM patients (all P<0.05). The Shunt group had significantly higher curative rate, shorter seroconversion time, hospitalization time, and disease duration (all P<0.001). However, no significant difference in the survival outcome was observed between groups (P=0.163). Cox proportional-hazard regression analysis showed that seroconversion time was the only independent factor associated with the survival outcome. Conclusion: Our results suggested that V-P shunt is an effective and safe treatment for non-HIV CM patients combined with intracranial hypertension. Seroconversion time was the only independent factor associated with the survival outcome.