Cryptococcosis among hospitalised patients with COVID-19: A multicentre research network study

Daniel B Chastain, Vanessa M Kung, Sahand Golpayegany, Brittany T Jackson, Carlos Franco-Paredes, Lilian Vargas Barahona, George R Thompson 3rd, Andrés F Henao-Martínez, Daniel B Chastain, Vanessa M Kung, Sahand Golpayegany, Brittany T Jackson, Carlos Franco-Paredes, Lilian Vargas Barahona, George R Thompson 3rd, Andrés F Henao-Martínez

Abstract

It is unclear if there is an association between COVID-19 and cryptococcosis. Therefore, this study aimed to describe the clinical features, risk factors, and outcomes associated with cryptococcosis in hospitalised patients with COVID-19. The objectives of this study were to determine the incidence of and examine factors associated with cryptococcosis after a diagnosis of COVID-19. We used TriNetX to identify and sort patients 18 years and older hospitalised with COVID-19 into two cohorts based on the presence or absence of a diagnosis of cryptococcosis following diagnosis of COVID-19. Outcomes of interest included the incidence of cryptococcosis following the diagnosis of COVID-19 as well as the proportion of patients in each group who had underlying comorbidities, received immunomodulatory therapy, required ICU admission or mechanical ventilation (MV), or died. Propensity score matching was used to adjust for confounding. Among 212,479 hospitalised patients with COVID-19, 65 developed cryptococcosis. The incidence of cryptococcosis following COVID-19 was 0.022%. Patients with cryptococcosis were more likely to be male and have underlying comorbidities. Among cases, 32% were people with HIV. Patients with cryptococcosis were more likely to have received tocilizumab (p < .0001) or baricitinib (p < .0001), but not dexamethasone (p = .0840). ICU admission (38% vs 29%), MV (23% vs 11%), and mortality (36% vs 14%) were significantly higher among patients with cryptococcosis. Mortality remained elevated after adjusted propensity score matching. Cryptococcosis occurred most often in hospitalised patients with COVID-19 who had traditional risk factors, comparable to findings in patients without COVID-19. Cryptococcosis was associated with increased ICU admission, MV, and mortality.

Keywords: COVID-19; SARS-CoV-2; cryptococcus; cytokine release syndrome; immunotherapy.

Conflict of interest statement

None.

© 2022 Wiley-VCH GmbH.

Figures

FIGURE 1
FIGURE 1
Distribution of underlying comorbidities among hospitalised patients with COVID‐19 stratified based on a diagnosis of cryptococcosis. The figure compares the percentage of HIV infection, neoplasms, transplanted organs or tissues, heart failure, chronic kidney disease (CKD), type 2 diabetes mellitus (DM2), and hepatic fibrosis and cirrhosis among hospitalised patients based on the presence (cases) or absence (control) of a diagnosis of cryptococcosis following diagnosis of COVID‐19. The asterisks denotes a statistically significant difference between groups
FIGURE 2
FIGURE 2
Percentage of hospitalised patients with COVID‐19 who received immunomodulatory therapies stratified based on a diagnosis of cryptococcosis. The figure compares the percentage of hospitalised patients with COVID‐19 with cryptococcosis (cases) to those without cryptococcosis (controls) who received dexamethasone, tocilizumab, or baricitinib. The asterisks denotes a statistically significant difference between groups
FIGURE 3
FIGURE 3
Kaplan–Meier survival analysis of hospitalised patients with COVID‐19 stratified based on a diagnosis of cryptococcosisThe figure displays the survival probability of hospitalised patients diagnosed with cryptococcosis within 3 months of the most recent COVID‐19 diagnosis (light grey line) and hospitalised patients without a diagnosis of cryptococcosis within 3 months of COVID‐19 diagnosis (dark grey line)
FIGURE 4
FIGURE 4
Instances of cryptococcosis following COVID‐19 among hospitalised patients. The figure displays the number of instances of cryptococcosis among hospitalised patients with COVID‐19 represented as a percentage of the cohort stratified by the number of days (dates) from COVID‐19 diagnosis to diagnosis of cryptococcosis

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Source: PubMed

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