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Establishment of a novel scoring model for mortality risk prediction in HIV-infected patients with cryptococcal
Ting Zhao1, Xiao-Lei Xu1, Jing-Min Nie1
1Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China.
Insights
A new scoring model accurately predicts mortality risk in HIV-infected patients with cryptococcal meningitis (CM). This tool helps physicians identify high-risk individuals for better prognosis assessment.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- HIV/AIDS Research
Background:
- Cryptococcal meningitis (CM) is a significant cause of mortality in HIV-infected individuals.
- Despite diagnostic and therapeutic advancements, predicting mortality in HIV/CM patients remains challenging.
Purpose of the Study:
- To develop and validate a novel scoring model for predicting mortality risk in HIV-infected patients with CM (HIV/CM).
Main Methods:
- A multicenter cohort study in China identified independent risk factors for mortality from 2013-2017.
- A scoring model was established and validated internally (bootstrapping) and externally (2018-2020 data).
Main Results:
- Six predictors (age, stiff neck, impaired consciousness, intracranial pressure, CD4+ T-cell count, urea) were associated with poor prognosis.
- The model achieved an area under the curve (AUC) of 0.876 for predicting mortality at admission.
- High sensitivity (74.1%) and specificity (83.8%) were observed with a cut-off of 5.5 points.
Conclusions:
- A simple, accurate six-variable scoring model was developed for screening high-risk HIV/CM patients.
- This model can aid physicians in assessing prognosis for HIV/CM inpatients.
Background:
Cryptococcal meningitis (CM) remains a leading cause of death in HIV-infected patients, despite advances in CM diagnostic and therapeutic strategies. This study was performed with the aim to develop and validate a novel scoring model to predict mortality risk in HIV-infected patients with CM (HIV/CM).
Methods:
Data on HIV/CM inpatients were obtained from a Multicenter Cohort study in China. Independent risk factors associated with mortality were identified based on data from 2013 to 2017, and a novel scoring model for mortality risk prediction was established. The bootstrapping statistical method was used for internal validation. External validation was performed using data from 2018 to 2020.
Results:
We found that six predictors, including age, stiff neck, impaired consciousness, intracranial pressure, CD4+ T-cell count, and urea levels, were associated with poor prognosis in HIV/CM patients. The novel scoring model could effectively identify HIV/CM patients at high risk of death on admission (area under curve 0.876; p<0.001). When the cut-off value of 5.5 points or more was applied, the sensitivity and specificity was 74.1 and 83.8%, respectively. Our scoring model showed a good discriminatory ability, with an area under the curve of 0.879 for internal validation via bootstrapping, and an area under the curve of 0.886 for external validation.
Conclusions:
Our developed scoring model of six variables is simple, convenient, and accurate for screening high-risk patients with HIV/CM, which may be a useful tool for physicians to assess prognosis in HIV/CM inpatients.
