{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T12:24:00Z","timestamp":1782563040179,"version":"3.54.5"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2019,5,21]],"date-time":"2019-05-21T00:00:00Z","timestamp":1558396800000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Increased intracranial pressure (ICP) is an important complication of cryptococcal meningitis (CM) and impacts morbidity and mortality. Factors associated with permanent ventriculoperitoneal (VP) shunt placement are poorly characterized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We conducted a retrospective cohort study of patients with CM at the University of Alabama at Birmingham from 1996 through 2015. Characteristics of patients at time of CM diagnosis who did and did not receive a VP shunt were compared with use of the 2-group chi-square test or Fisher exact test for categorical variables and the 2-group t test for continuous variables. Stepwise logistic regression analysis was used to determine predictors of shunt placement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 422 patients with cryptococcosis, 257 (60.9%) had CM. Mean age was 47.7 years, 71.6% were male, and 44.4% were African American. The most common underlying conditions were HIV (42.4%), solid organ transplantation (29.6%), and corticosteroid use (34.2%). Forty-four (17.1%) received a VP shunt a median of 17 days (range, 1\u2013320 days) post-diagnosis. By multivariable analysis, baseline opening pressure &amp;gt;30 cm H2O (OR, 9.4; 95% CI, 3.0, 28.8; P &amp;lt; .0001), being a normal host (OR, 6.3; 95% CI, 1.5, 26.1; P = .011) and hydrocephalus (OR, 4.9, 95% CI, 1.3, 17.9); P = .017) were associated with increased odds of shunting (Table 2). In contrast, age (OR, 0.96; 95% CI, 0.92, 0.99; P = .037) and male gender (OR, 0.18; 95% CI, 0.06, 0.55; P = .023) were associated with decreased odds of shunting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Identification of factors at time of CM diagnosis associated with need for permanent VP shunt placement may allow for earlier, more aggressive treatment and potentially improve outcomes associated with increased ICP from cryptococcal meningitis.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ofid\/ofz241","type":"journal-article","created":{"date-parts":[[2019,5,21]],"date-time":"2019-05-21T07:30:01Z","timestamp":1558423801000},"source":"Crossref","is-referenced-by-count":20,"title":["Factors Associated With Ventriculoperitoneal Shunt Placement in Patients With Cryptococcal Meningitis"],"prefix":"10.1093","volume":"6","author":[{"given":"John W","family":"Baddley","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham"},{"name":"Medical Service, Birmingham VA Medical Center, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"George R","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology"},{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of California\u2013Davis Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen O","family":"Riley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary K","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A","family":"Moser","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G","family":"Pappas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,5,20]]},"reference":[{"key":"2020081003572486700_CIT0001","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1086\/649858","article-title":"Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America","volume":"50","author":"Perfect","year":"2010","journal-title":"Clin Infect Dis"},{"key":"2020081003572486700_CIT0002","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1086\/313603","article-title":"Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis. The NIAID Mycoses Study Group and AIDS Cooperative Treatment Groups","volume":"30","author":"Graybill","year":"2000","journal-title":"Clin Infect Dis"},{"key":"2020081003572486700_CIT0003","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1086\/427222","article-title":"Managing cryptococcal meningitis is about handling the pressure","volume":"40","author":"Pappas","year":"2005","journal-title":"Clin Infect Dis"},{"key":"2020081003572486700_CIT0004","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1097\/QAD.0b013e32832605fe","article-title":"Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures","volume":"23","author":"Bicanic","year":"2009","journal-title":"AIDS"},{"key":"2020081003572486700_CIT0005","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1093\/cid\/ciu596","article-title":"The effect of therapeutic lumbar punctures on acute mortality from cryptococcal 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