Wang Mengyan, Dong Xiaotian, Wan Hu, Zhang Binhai, Yu Lele, Yu Wenyan, Zhang Yan, Pan Kenv, Wang Miaochan, Xu Aifang, Jin Yujiao
Department II of Infectious Diseases, Hangzhou Xixi Hospital, Hangzhou Sixth People's Hospital, Hangzhou, China.
Department of Clinical Laboratory, The First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, 310003, China.
Heliyon. 2024 Jul 4;10(13):e34024. doi: 10.1016/j.heliyon.2024.e34024. eCollection 2024 Jul 15.
This case-control study aimed to analyze the characteristics and risk factors for death in HIV-positive Talaromycosis marneffei (TSM) patients with sepsis.
We retrospectively reviewed 173 AIDS patients diagnosed with TSM infection from January 1, 2013, to December 1, 2023, at Hangzhou Xixi Hospital. We collected and analyzed clinical characteristics, laboratory findings, bone marrow cytology results, treatment, and prognosis.
Out of 173 AIDS-TSM patients, 92 had sepsis while 81 did not. AIDS-TSM patients with sepsis have a higher in-hospital mortality rate (19.6 %) than non-sepsis patients (0 %). The SOFA score showed a significant association with in-hospital mortality in AIDS-TSM patients with sepsis (OR = 1.583, 95 % CI: 1.183-2.118, P = 0.002), indicating an almost linear relationship. After adjusting for the SOFA score, only hemoglobin (Hb) (OR = 0.971, 95 % CI: 0.943-1.000, P = 0.046), international normalized ratio (INR) (OR = 22.33, 95 % CI: 1.84-270.90, P = 0.015), and C-reactive protein (CRP) (OR = 1.014, 95 % CI: 1.001-1.027, P = 0.039) remained significantly associated with in-hospital mortality. The Receiver Operating Characteristic (ROC) curve of the SOFA score, INR, and CRP showed moderately good predictive performance for in-hospital mortality, while Hb had a low predictive performance. The Area Under Curve (AUC) values were 0.834, 0.820, 0.776, and 0.669, respectively.
AIDS-TSM patients with sepsis have a higher mortality rate. Moreover, the SOFA score, along with Hb, INR, and CRP, are the risk factors for death in AIDS-TSM patients with sepsis.
本病例对照研究旨在分析合并脓毒症的HIV阳性马尔尼菲篮状菌病（TSM）患者的死亡特征及危险因素。
我们回顾性分析了2013年1月1日至2023年12月1日在杭州西溪医院确诊为TSM感染的173例艾滋病患者。我们收集并分析了临床特征、实验室检查结果、骨髓细胞学结果、治疗情况及预后。
在173例艾滋病合并TSM患者中，92例合并脓毒症，81例未合并脓毒症。合并脓毒症的艾滋病合并TSM患者的院内死亡率（19.6%）高于未合并脓毒症的患者（0%）。序贯器官衰竭评估（SOFA）评分与合并脓毒症的艾滋病合并TSM患者的院内死亡率显著相关（OR = 1.583，95%CI：1.183 - 2.118，P = 0.002），呈近似线性关系。校正SOFA评分后，仅血红蛋白（Hb）（OR = 0.971，95%CI：0.943 - 1.000，P = 0.046）、国际标准化比值（INR）（OR = 22.33，95%CI：1.84 - 270.90，P = 0.015）和C反应蛋白（CRP）（OR = 1.014，95%CI：1.001 - 1.027，P = 0.039）与院内死亡率仍显著相关。SOFA评分、INR和CRP的受试者工作特征（ROC）曲线对院内死亡率显示出中等良好的预测性能，而Hb的预测性能较低。曲线下面积（AUC）值分别为0.834、0.820、0.776和0.669。
合并脓毒症的艾滋病合并TSM患者死亡率较高。此外，SOFA评分以及Hb、INR和CRP是合并脓毒症的艾滋病合并TSM患者的死亡危险因素。
