Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University.
The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University.
Biosci Trends. 2019 May 12;13(2):136-144. doi: 10.5582/bst.2018.01309. Epub 2019 Mar 29.
We construct and validate a non-invasive clinical scoring model to predict mortality in HIV/TB patients at end stage of AIDS in China. There were 1,007 HIV/TB patients admitted to Beijing Ditan Hospital from August 2009 to January 2018 included in this study, who were randomly assigned to form derivation cohort and validation cohort. A clinical scoring model was developed based on predictors associated with mortality identified with Cox proportional hazard models. The discrimination and accuracy of model were further validated using the area under the ROC curves. The derivation and validation cohort consisted of 807 and 200 patients in 8:2 ratio, respectively. In derivation cohort, anemia (HGB < 90g/L), tuberculous meningitis, severe pneumonia, hypoalbuminemia, unexplained infections or space-occupying lesions, and malignancies remained independent risk factors of mortality in HIV/TB co-infected patients, and included in this clinical scoring model. The model indicated good discrimination, including AUC = 0.858 (95% CI: 0.782-0.943) in the derivation cohort, and AUC = 0.867 (95% CI: 0.832-0.902) in validation cohort, respectively. The predicted scores were categorized into two groups to predict the mortality: low-risk (0-2 points with mortality with 3.6-9.1%) and high-risk (4-16 points with mortality with 26.42-74.62%), in which 54.55% and 74.62% of patients with score of 5 to 11 and 12-16 were died among high-risk group. Kaplan-Meier curve indicated a significant difference in the cumulative mortality in the two groups by log-rank test (p < 0.001). A clinical scoring model to assess the prognosis in HIV/TB patients at end stage of AIDS was constructed based on simple laboratory and clinical features available at admission, which may be an easy-to-use tool for physicians to evaluate the prognosis and treatment outcome in HIV/TB co-infected patients. The model was also applicable for predicting the death of end-stage HIV/TB patients within a 12 months period after discharge.
我们构建并验证了一种非侵入性临床评分模型，用于预测中国艾滋病晚期 HIV/TB 患者的死亡率。本研究纳入了 2009 年 8 月至 2018 年 1 月期间北京地坛医院收治的 1007 例 HIV/TB 患者，他们被随机分为推导队列和验证队列。基于 Cox 比例风险模型确定的与死亡率相关的预测因素，建立了临床评分模型。使用 ROC 曲线下面积进一步验证了模型的区分度和准确性。推导队列和验证队列分别包含 807 例和 200 例患者，比例为 8:2。在推导队列中，贫血（HGB < 90g/L）、结核性脑膜炎、重症肺炎、低蛋白血症、原因不明的感染或占位性病变和恶性肿瘤仍然是 HIV/TB 合并感染患者死亡的独立危险因素，并包含在该临床评分模型中。该模型显示出良好的区分度，推导队列的 AUC 为 0.858（95%CI：0.782-0.943），验证队列的 AUC 为 0.867（95%CI：0.832-0.902）。将预测评分分为两组以预测死亡率：低危（0-2 分，死亡率为 3.6-9.1%）和高危（4-16 分，死亡率为 26.42-74.62%），高危组中评分在 5-11 分和 12-16 分的患者分别有 54.55%和 74.62%死亡。对数秩检验的 Kaplan-Meier 曲线表明两组间累积死亡率有显著差异（p<0.001）。基于入院时可获得的简单实验室和临床特征，构建了一种用于评估艾滋病晚期 HIV/TB 患者预后的临床评分模型，这可能是一种易于使用的工具，用于评估 HIV/TB 合并感染患者的预后和治疗结果。该模型也适用于预测出院后 12 个月内晚期 HIV/TB 患者的死亡。
