Rambiki Ethel, Thawani Agness, Kapenga Davis, Malunda Chikaiko, Mseke Boniface, Mpesi Patrick, Ganesh Prakash, Steffen Hans-Michael, Heller Tom, Wallrauch Claudia
Lighthouse Trust, Area 33, Mzimba Street, P. O. Box 106, Lilongwe, 207233, Malawi.
Lighthouse Trust, Lilongwe, Malawi.
Ther Adv Infect Dis. 2025 Jun 5;12:20499361251341385. doi: 10.1177/20499361251341385. eCollection 2025 Jan-Dec.
People with advanced HIV admitted to hospitals are at high risk of mortality. Serious illness can be identified using WHO-defined danger signs ("WHO score") or bedside scores like the quick Sequential Organ Failure Assessment (qSOFA) score.
The study aimed at assessing clinical parameters as predictors of in-hospital mortality for people with HIV (PWH) admitted for routine medical care.
A prospective observational study of all PWH admitted to medical wards at Kamuzu Central Hospital, Lilongwe, Malawi.
WHO danger signs and qSOFA score were determined at the first encounter, CD4 count tests were performed, and discharge outcomes were recorded. The discriminatory power of different scores for predicting in-hospital mortality was assessed using the area under receiver-operating-characteristic curves (AUROCs).
From November 2022 to May 2023, 401 adults aged ⩾18 years were admitted. Advanced HIV disease (CD4 < 200 cells/mm) was present in 55.2% (95% CI 50.2-60.2). Overall, in-hospital mortality was 25.7% (95% CI 21.3-30.0). Neither sex, age, CD4 count, nor BMI < 18.5 was significantly associated with mortality. Both the WHO score and qSOFA score were significantly associated with increasing mortality. AUROC for WHO score and qSOFA were 0.68 (95% CI 0.61-0.75) and 0.71 (95% CI 0.64-0.78), respectively. Including BMI or CD4 did not significantly improve AUROC. Using only the individual danger sign "inability-to-walk-unaided" yielded a similar AUROC of 0.68 (95% CI 0.61-0.75).
Increasing WHO danger sign scores were associated with in-hospital mortality; adding BMI or CD4 did not improve predictive accuracy. Notably, the predictive information derived from a single parameter-inability-to-walk-unaided-was as effective as the complete WHO score and was easier to obtain. Given the challenges in comprehensive vital sign recording, this simple measure may prove valuable in triaging PWH admitted to hospitals in resource-limited settings such as Malawi.
入住医院的晚期艾滋病病毒感染者死亡风险很高。可使用世界卫生组织定义的危险信号（“WHO评分”）或床边评分，如快速序贯器官衰竭评估（qSOFA）评分来识别严重疾病。
本研究旨在评估临床参数作为因常规医疗护理入院的艾滋病病毒感染者（PWH）院内死亡的预测指标。
对马拉维利隆圭卡木祖中央医院内科病房收治的所有PWH进行一项前瞻性观察性研究。
在首次接诊时确定WHO危险信号和qSOFA评分，进行CD4细胞计数检测，并记录出院结局。使用受试者工作特征曲线下面积（AUROCs）评估不同评分对预测院内死亡的辨别能力。
2022年11月至2023年5月，收治了401名年龄≥18岁的成年人。55.2%（95%CI 50.2 - 60.2）的患者存在晚期艾滋病病毒疾病（CD4＜200个细胞/mm³）。总体而言，院内死亡率为25.7%（95%CI 21.3 - 30.0）。性别、年龄、CD4细胞计数以及BMI＜18.5均与死亡率无显著相关性。WHO评分和qSOFA评分均与死亡率增加显著相关。WHO评分和qSOFA评分的AUROCs分别为0.68（95%CI 0.61 - 0.75）和0.71（95%CI 0.64 - 0.78）。纳入BMI或CD4并未显著提高AUROCs。仅使用单个危险信号“无法独立行走”产生的AUROCs相似，为0.68（95%CI 0.61 - 0.75）。
WHO危险信号评分增加与院内死亡率相关；添加BMI或CD4并未提高预测准确性。值得注意的是，从单个参数“无法独立行走”得出的预测信息与完整的WHO评分一样有效，且更易于获取。鉴于全面记录生命体征存在挑战，这种简单的测量方法在对马拉维等资源有限环境中入住医院的PWH进行分诊时可能很有价值。
