Evidence map›Paper›PMID 25057102›Full record

Trial reportClinical infectious diseases : an official publication of the Infectious Diseases Society of America2014

The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis.

Melissa A Rolfes, Kathy Huppler Hullsiek, Joshua Rhein, Henry W Nabeta, Kabanda Taseera, Charlotte Schutz, Abdu Musubire, Radha Rajasingham, Darlisha A Williams, Friedrich Thienemann and 4 more

Erratum issued Registry-linked trialOpen access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT01075152 (Trial for the Optimal Timing of HIV Therapy After Cryptococcal Meningitis), which is not on this map. Cited by 103 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
103citing papers in PubMed, 5 pooled it
9.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01075152 phase4completednot on this map

Trial for the Optimal Timing of HIV Therapy After Cryptococcal Meningitis

TypeinterventionalSponsorUniversity of MinnesotaRan2010 to 2013Enrolled177ConditionsCryptococcal Meningitis, HIV Infections, AIDSArmsefavirenz, nucleoside
3 · Its place in the literature

Who cites it

103 citing papers in PubMed, 5 syntheses or guidelines pooled it, 186 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Pooled it
  4. Treatment for HIV-associated cryptococcal meningitis.The Cochrane database of systematic reviews · 2018
    Pooled it
  5. Pooled it
  6. Trial
  7. Trial
  8. Trial
  9. Article
  10. Article
  11. Review
  12. Article
  13. Review
  14. Review
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  17. Review
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43 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 6 institutions in 4 countries.

Melissa A RolfesDepartment of Medicine, Medical School.
Kathy Huppler HullsiekDivision of Biostatistics, School of Public Health, University of Minnesota, Minneapolis.
Joshua RheinDepartment of Medicine, Medical School Infectious Diseases Institute, Makerere University, Kampala.
Henry W NabetaInfectious Diseases Institute, Makerere University, Kampala.
Kabanda TaseeraInternal Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Uganda.
Charlotte SchutzInstitute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, South Africa.
Abdu MusubireInfectious Diseases Institute, Makerere University, Kampala.
Radha RajasinghamDepartment of Medicine, Medical School Infectious Diseases Institute, Makerere University, Kampala.
Darlisha A WilliamsDepartment of Medicine, Medical School Infectious Diseases Institute, Makerere University, Kampala.
Friedrich ThienemannInstitute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, South Africa.
Conrad MuzooraInternal Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Uganda.
Graeme MeintjesInstitute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, South Africa Department of Medicine, Imperial College London, United Kingdom;
David B MeyaDepartment of Medicine, Medical School Infectious Diseases Institute, Makerere University, Kampala School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
David R BoulwareDepartment of Medicine, Medical School.
Infectious Diseases Institute · UGMakerere University · UGMbarara University of Science and Technology · UGUniversity of Cape Town · ZAImperial College London · GBUniversity of Minnesota · US

Funding

Trial for the Optimal Timing of HIV Therapy after Cryptococcal MeningitisU01AI089244 · NIAID · UNIVERSITY OF MINNESOTA · PI BOULWARE, DAVID R · 2010 to 2014
$7.6M
Infectious Disease Training in Clinical InvestigationT32AI055433 · NIAID · UNIVERSITY OF MINNESOTA TWIN CITIES · PI David R Boulware · 2003 to 2026
$6.1M
Immune Reconstitution Syndrome in HIV infected Persons in Resource-Limited AreasK23AI073192 · NIAID · UNIVERSITY OF MINNESOTA · PI BOULWARE, DAVID R · 2009 to 2012
$530k
Impact of HIV and HIV therapy on the Etiology and Outcome of Meningitis in UgandaR21NS065713 · NINDS · UNIVERSITY OF MINNESOTA · PI BOHJANEN, PAUL R, BOULWARE, DAVID R · 2010 to 2011
$276k
NIAID NIH HHS K23 AI073192NIAID NIH HHS K23AI073192NIAID NIH HHS T32 AI055433NIAID NIH HHS T32AI055433NIAID NIH HHS U01 AI089244NIAID NIH HHS U01AI089244NINDS NIH HHS R21 NS065713NINDS NIH HHS R21NS065713Wellcome TrustWellcome Trust 081667Wellcome Trust 098316
6 · The paper itself

Abstract

introductionCryptococcal meningitis is the most common cause of adult meningitis in sub-Saharan Africa. Raised intracranial pressure (ICP) is common in cryptococcosis. Prior studies suggest elevated ICP is associated with mortality, and guidelines recommend frequent lumbar punctures (LPs) to control ICP. However, the magnitude of the impact of LPs on cryptococcal-related mortality is unknown.

methodsIn sum, 248 individuals with human immunodeficiency virus (HIV)-associated cryptococcal meningitis, screened for the Cryptococcal Optimal ART Timing (COAT) trial in Uganda and South Africa, were observed. Individuals received an LP to diagnose meningitis, and subsequent therapeutic LPs were recommended for elevated ICP (>250 mmH2O) or new symptoms. We compared survival, through 11 days, between individuals receiving at least 1 therapeutic LP with individuals not receiving therapeutic LPs. The COAT trial randomized subjects at 7-11 days; thus, follow-up stopped at time of death, randomization, or 11 days.

resultsSeventy-five (30%) individuals had at least 1 therapeutic LP. Individuals receiving therapeutic LPs had higher cerebrospinal fluid (CSF) opening pressures, higher CSF fungal burdens, and were more likely to have altered mental status at baseline than those with no therapeutic LPs. Thirty-one deaths (18%) occurred among 173 individuals without a therapeutic LP and 5 deaths (7%) among 75 with at least 1 therapeutic LP. The adjusted relative risk of mortality was 0.31 (95% confidence interval: .12-.82). The association was observed regardless of opening pressure at baseline.

conclusionsTherapeutic LPs were associated with a 69% relative improvement in survival, regardless of initial intracranial pressure. The role of therapeutic LPs should be reevaluated.

Indexed as

AIDS-Related Opportunistic InfectionsMeningitis, CryptococcalSpinal PunctureAdultCohort StudiesFemaleHumansIntracranial HypertensionMalecryptococcal meningitisepidemiologyHIVmortalitytherapeutic lumbar punctures

Identifiers

PMID25057102
PMCPMC4441057
OpenAlexW2102241097

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.