Anti-GM-CSF autoantibodies predict outcome of cryptococcal meningitis in patients not infected with HIV: a cohort study

ObjectivesTo explore the seroprevalence of anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies in non-HIV cryptococcal meningitis (CM) and assess its predictive value for survival.MethodsThis is a retrospective study of 12 years of non-HIV CM. We detected serum anti-GM-CSF autoantibodies, evaluated the clinical features and outcomes, together with the exploration of prognostic factors for 2-week and 1-year survival.ResultsA total of 584 non-HIV CM cases were included. 301 of 584 patients (51.5%) were phenotypically healthy. 264 Cryptococcus isolates were obtained from cerebrospinal fluid (CSF) culture, of which 251 were identified as C. neoformans species complex and 13 as C. gattii species complex. 37 of 455 patients (8.1%) tested positive for serum anti-GM-CSF autoantibodies. Patients with anti-GM-CSF autoantibodies were more susceptible to C. gattii species complex infection (66.7% vs. 6.3%, p < 0.001) and more likely to develop pulmonary mass lesions with a diameter > 3 centimetres (42.9% vs. 6.5%, p 0.001). Of 584 patients 16 (2.7%) died within 2 weeks, 77 of 563 patients (13.7%) died at 1 year, and 93 of 486 patients (19.1%) lived with disabilities at 1 year. Univariant Cox regression analysis found that anti-GM-CSF autoantibodies were associated with lower 1-year survival (HR 2.66, 95% CI 1.34–5.27, p 0.005). Multivariable Cox proportional hazards modelling revealed that CSF cryptococcal antigen titres ≥ 1:1280 were associated with both, reduced 2-week and 1-year survival rates (HR 5.44, 95% CI 1.23–24.10, p 0.026 and HR 5.09, 95% CI 1.95–13.26, p 0.001).ConclusionsPresence of serum anti-GM-CSF autoantibodies is predictive of poor outcomes, regardless of host immune status and the causative Cryptococcus species complex.