Lumbar puncture frequency and patient survival among persons hospitalized with cryptococcal meningitis in the United States

Elevated intracranial pressure contributes to high mortality in cryptococcal meningitis. We evaluated the association between therapeutic lumbar punctures (LPs) and survival among patients hospitalized with cryptococcal meningitis in the United States. Repeat LPs were associated with lower mortality (hazard ratio [HR] 0.38; 95% confidence interval (CI), 0.29-0.49) overall, in people with HIV (HR 0.33; 95% CI, 0.21-0.50), in transplant recipients (HR 0.21; 95% CI, 0.08-0.58), and in persons without HIV or transplant (HR 0.44; 95% CI, 0.30-0.64) compared with receipt of only diagnostic LP. Findings support guideline-recommended repeat LP across diverse populations.