脆弱性 RISC-HIV 的开发：一种用于预测 HIV 感染者短期护理中脆弱性风险的风险评分。
Development of Frail RISC-HIV: a Risk Score for Predicting Frailty Risk in the Short-term for Care of People with HIV.
机构信息
University of Washington, Seattle, Washington, USA.
University of Manitoba, Winnipeg, Manitoba, Canada.
出版信息
AIDS. 2023 May 1;37(6):967-975. doi: 10.1097/QAD.0000000000003501. Epub 2023 Jan 31.
OBJECTIVE
Frailty is common among people with HIV (PWH), so we developed frail risk in the short-term for care (RISC)-HIV, a frailty prediction risk score for HIV clinical decision-making.
DESIGN
We followed PWH for up to 2 years to identify short-term predictors of becoming frail.
METHODS
We predicted frailty risk among PWH at seven HIV clinics across the United States. A modified self-reported Fried Phenotype captured frailty, including fatigue, weight loss, inactivity, and poor mobility. PWH without frailty were separated into training and validation sets and followed until becoming frail or 2 years. Bayesian Model Averaging (BMA) and five-fold-cross-validation Lasso regression selected predictors of frailty. Predictors were selected by BMA if they had a greater than 45% probability of being in the best model and by Lasso if they minimized mean squared error. We included age, sex, and variables selected by both BMA and Lasso in Frail RISC-HIV by associating incident frailty with each selected variable in Cox models. Frail RISC-HIV performance was assessed in the validation set by Harrell's C and lift plots.
RESULTS
Among 3170 PWH (training set), 7% developed frailty, whereas among 1510 PWH (validation set), 12% developed frailty. BMA and Lasso selected baseline frailty score, prescribed antidepressants, prescribed antiretroviral therapy, depressive symptomology, and current marijuana and illicit opioid use. Discrimination was acceptable in the validation set, with Harrell's C of 0.76 (95% confidence interval: 0.73-0.79) and sensitivity of 80% and specificity of 61% at a 5% frailty risk cutoff.
CONCLUSIONS
Frail RISC-HIV is a simple, easily implemented tool to assist in classifying PWH at risk for frailty in clinics.
目的
艾滋病毒感染者（HIV 感染者）中普遍存在虚弱问题，因此我们开发了用于 HIV 临床决策的短期虚弱风险-艾滋病毒（RISC-HIV），这是一种虚弱预测风险评分。
设计
我们对美国 7 家 HIV 诊所的 HIV 感染者进行了长达 2 年的随访，以确定短期虚弱的预测因素。
方法
我们预测了美国 7 家 HIV 诊所的 HIV 感染者的虚弱风险。改良的自我报告弗莱德表型（包括疲劳、体重减轻、不活动和行动不便）捕捉了虚弱。没有虚弱的 HIV 感染者被分为训练集和验证集，并随访至虚弱或 2 年。贝叶斯平均模型（BMA）和 5 倍交叉验证套索回归选择了虚弱的预测因素。BMA 选择的预测因素，如果它们在最佳模型中的概率大于 45%，则会被选中；如果它们最小化均方误差，则会被 Lasso 选中。我们在 Frail RISC-HIV 中通过关联 Cox 模型中每个选定变量与虚弱的关系，将年龄、性别和 BMA 和 Lasso 均选择的变量纳入其中。在验证集中通过 Harrell 的 C 和提升图评估 Frail RISC-HIV 的性能。
结果
在 3170 名 HIV 感染者（训练集）中，有 7%发展为虚弱，而在 1510 名 HIV 感染者（验证集）中，有 12%发展为虚弱。BMA 和 Lasso 选择了基线虚弱评分、处方抗抑郁药、处方抗逆转录病毒治疗、抑郁症状和当前大麻和非法阿片类药物使用。在验证集中，区分度尚可，Harrell 的 C 为 0.76（95%置信区间：0.73-0.79），灵敏度为 80%，特异性为 61%，虚弱风险为 5%。
结论
Frail RISC-HIV 是一种简单、易于实施的工具，可用于在诊所中帮助分类有虚弱风险的 HIV 感染者。
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