Predictors of mortality in hospitalized patients with disseminated histoplasmosis

Abstract

Introduction

Histoplasmosis is an important opportunistic infection among People Living with HIV (PLHIV) and still presents significant mortality. Reliable prognostic markers are essential to guide early management and appropriate clinical decision-making. This study aimed to evaluate predictors of death at admission among patients with disseminated histoplasmosis.

Methods

This was a single-center retrospective cohort study including adults with HIV and disseminated histoplasmosis admitted to a Brazilian tertiary hospital between 2009 and 2023. The primary outcome was in-hospital mortality. Variables collected at admission were analyzed using univariate and multivariate approaches.

Results

The study included 105 adults, with a median age of 39-years, predominantly male (82.8%), and presenting severe immunosuppression (median CD4+ T-cell count of 63 cells/µL). Thirty patients (28.5%) died during hospitalization. Elevated urea, ferritin, and Lactate Dehydrogenase (LDH) levels were associated with higher mortality. Coinfections, including pneumocystosis and mycobacterial infections, showed no statistically significant association with the outcome. Multivariate analysis identified tachypnea as the only independent predictor of mortality (OR = 3.9; 95% CI 1.39–10.97; p < 0.001), whereas dysphagia remained a protective factor (OR = 0.18; 95% CI 0.03–0.98; p = 0.047).

Conclusions

Tachypnea at admission was the only independent predictor of in-hospital mortality. Dysphagia may promote earlier healthcare-seeking behavior, potentially contributing to lower mortality. These findings represent noninvasive and low-cost measures that may be useful for early risk stratification and resource optimization in resource-limited endemic settings.