ArticlePLoS neglected tropical diseases2025
Prognostic model of HIV-associated talaromycosis in south China: A large-scale retrospective study.
Article in PLoS neglected tropical diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHIV-associated talaromycosis causes substantial mortality despite available therapies. Early identification of high-risk patients remains challenging, particularly in resource-limited settings. We aimed to develop and validate a dynamic prognostic model for rapid risk stratification.
methodsThis retrospective cohort study analyzed 1,892 HIV-talaromycosis patients admitted to Guangzhou Eighth People's Hospital (2011-2023). Poor outcome (in-hospital death or deterioration-related discharge) was the primary endpoint. A nomogram was developed using Cox regression on admission variables in a training set (2011-2020, N = 1,435), with internal validation set (2011-2020, N = 431) and independent testing set (2021-2023, N = 457). Performance was assessed via time-dependent AUC, C-index, calibration, and decision curve analysis.
resultsPoor outcomes occurred in 14.1% of cases (266/1,892), with 86.5% of these events happening within 28 days. Winter admissions exhibited the lowest case volume but the highest poor outcome rate. Multivariable analysis revealed eight independent readily available predictors: absence of lymphadenopathy (aHR: 0.581, 95%CI: 0.396-0.852, P = 0.005) and hepatosplenomegaly (aHR: 0.347, 95%CI: 0.232-0.519, P < 0.001), respiratory rate (aHR: 1.041, 95%CI: 1.007-1.076, P = 0.016), white blood cell count (aHR: 1.089, 95%CI: 1.049-1.132, P < 0.001), platelet count (aHR: 0.995, 95%CI: 0.992-0.997, P < 0.001), albumin level (aHR: 0.911, 95%CI: 0.872-0.952, P < 0.001), lactate dehydrogenase (aHR: 1.000, 95%CI: 1.000-1.000, P < 0.001), and blood urea nitrogen (aHR: 1.087, 95%CI: 1.068-1.106, P < 0.001). The above indicators were stratified according to predefined classifications and used to established a nomogram. The nomogram demonstrated strong discriminatory performance for 7-, 14-, and 28-day outcomes (AUC 0.905/0.863/0.838 in development; 0.851/0.832/0.807 in independent testing; C-index 0.813-0.841). Calibration curve analysis demonstrated that the nomogram exhibited excellent predictive accuracy and decision curve analysis indicated substantial clinical benefit. The model could effectively differentiate between high-risk and low-risk populations.
conclusionThis study provides a dynamically validated prognostic tool for HIV-associated talaromycosis, enabling risk stratification using readily available clinical data. Its integration into electronic health systems could off an opportunity to optimize resource allocation and improve outcomes in endemic regions.
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