Presentation and Prognosis of Cryptococcosis Requiring Intensive Care Unit Admission in France: The CRYPTO-ICU Study

Abstract Background Cryptococcus causes life-threatening opportunistic infections in immunocompromised hosts. Data on the most severe cases requiring intensive care unit (ICU) admission remain limited. Methods We conducted a retrospective, multicenter study of patients admitted to 30 French ICUs for severe cryptococcosis between 2000 and 2022. Results Among 151 patients included, 56.9% were patients with human immunodeficiency virus (HIV). Cases in patients without HIV became increasingly prevalent over time (51.3% in 2012–2022 vs 32.4% before 2012); 82.5% were receiving immunosuppressive therapy. Central nervous system infection was predominant (91.1%), followed by lung infection (39.7%). Fungemia occurred in 59.8% patients, and 75.2% had disseminated infection. Neurological failure was the leading organ impairment at admission (75.5%) followed by respiratory failure (47.7%), acute kidney injury (41.7%), and shock (24.5%). The median Sequential Organ Failure Assessment (SOFA) score was 4 (interquartile range, 2–7). Invasive mechanical ventilation, vasopressors, and renal replacement therapy were required in 54.9%, 34.4%, and 18.5% of patients, respectively. At day 90, 94% of patients requiring mechanical ventilation and vasopressors were deceased, compared to 38.7% with invasive ventilation alone and 17.2% without any organ support (P < .001). Overall, 90-day mortality reached 49.6%. SOFA score (adjusted hazard ratio [aHR], 1.04 [95% confidence interval [CI], 1.02–1.06]), admission between 2000 and 2012 (aHR, 2.30 [95% CI, 1.36–3.89]), disseminated infection (aHR, 2.32 [95% CI, 1.15–4.67]), and initiation of antifungal therapy before ICU admission (aHR, 0.38 [95% CI, .22–.63]) were independently associated with 90-day mortality, whereas HIV serostatus was not (aHR, 0.93 [95% CI, .47–1.84]). Conclusions Severe cryptococcosis requiring ICU admission affects an increasing number of patients without HIV and is associated with high, though declining, mortality. Early diagnosis and treatment are mandatory to improve prognosis.