Clinical characteristics and predictors of one-year mortality in HIV and non-HIV patients with cryptococcal infections in a middle-income setting: a multicenter cohort study

Abstract

Cryptococcal infections remain life-threatening fungal infections affecting both people living with HIV (PLWH) and non-HIV populations. Data from real-world cohorts in middle-income settings, particularly those including both groups, remain limited. This study aimed to evaluate the clinical characteristics and identify predictors of one-year mortality in patients with cryptococcal infections. Methods: In this retrospective multicenter cohort study, adult patients diagnosed with cryptococcal infection between 2013 and 2025 were included and followed for one year after diagnosis or until death. Demographic, clinical, laboratory, and treatment data were collected. Survival was analyzed using Kaplan–Meier methods and compared with the log-rank test. Cox proportional hazards regression was used to identify factors independently associated with mortality. Subgroup analyses were performed according to HIV status. Results: A total of 92 patients with an average age of 46 ± 16 years were included; 56.5% were PLWH, and 87% were immunocompromised. Central nervous system involvement was the most common presentation (64.1%). Overall one-year mortality was 46.7%. In the multivariable Cox regression analysis, altered consciousness (HR 3.110, 95% CI 1.624–5.956, p < 0.001) and disseminated infection (HR 2.155, 95% CI 1.156–4.016, p = 0.016) were independently associated with increased mortality, whereas higher serum albumin levels were independently associated with improved survival (HR 0.532, 95% CI 0.328–0.861, p = 0.010). Age remained independently associated with mortality (HR 1.025 per year, 95% CI 1.006–1.045, p = 0.010). Kaplan–Meier analysis showed significantly lower one-year survival among patients with altered consciousness and disseminated infection. Although CNS involvement was more frequent among PLWH (78.8% vs. 45%, p < 0.001), mortality rates were comparable between PLWH and non-HIV patients. Conclusions: Cryptococcal infections are associated with high mortality regardless of HIV status. Altered consciousness and disseminated infection were independently associated with one-year mortality, whereas higher albumin levels were associated with improved survival. Simple clinical parameters may contribute to early clinical risk assessment, particularly in resource-limited settings.