Risk score can accurately predict in-hospital mortality of HIV-positive patients

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Researchers in South Africa have developed and validated a risk score to predict in-hospital mortality of HIV-infected patients requiring hospitalization.

The study, published in HIV medicine, analyzed data from 1,224 HIV-positive patients who presented to the emergency department at Charlotte Maxeke Johannesburg Academic Hospital in South Africa between July 7, 2017 and October 18, 2018. The study excluded patients who were referred to another facility, were HIV negative. or unknown HIV status or did not consent. The overall hospital mortality rate was 13.6% (n = 166). The risk score was developed using multivariate logistic regression.

“The HIV Hospital Mortality Prediction Risk Score (HIV-IMP) exhibits good discrimination and overall calibration and is relatively easy to use,” the study authors, led by Abdullah E. Laher , MB, BCH, MMed, FLEM, of The University of the Witwatersrand in Johannesburg, South Africa, wrote. “Further studies should aim to validate the score externally in various clinical settings. “

After internal validation using the bootstrap technique, the discrimination, assessed using the area under the receiver operating characteristic curve, was good (AUROC = 0.83, 95% CI: 0, 78-0.88). The calibration was also good (Hosmer – Lemeshow χ2 = 2.26, p = 0.895).

“The risk score is relatively simple to use and includes only eight predictor variables, four of which are not lab-based,” the authors wrote.

Variables that can be readily acquired on arrival at the emergency department include patients not adhering to antiretroviral therapy or not yet on ART, Glasgow under 15 scale, lower respiratory rate at 20 breaths per minute and oxygen saturation less than 90%.

Other variables acquired through laboratory analyzes are the number of white blood cells less than 4000 per microliter (4 × 109 / L), creatinine greater than 120 micromoles per liter (120 μmol / L), lactate greater than 2 millimoles per liter (2 mmol / L) and albumin less than 35 grams per liter (35 g / L).

“It is hoped that the HIV-IMP risk score will positively contribute to the timely and appropriate management of critically ill HIV-positive patients requiring hospitalization,” he wrote, adding that it could be useful in guiding treatment. clinical decision, guide the allocation of scarce resources and influence the disposition of patients.

The limitations of the study include that this was a single-center study and may have been influenced by the availability of resources, clinical management protocols and the expertise of clinicians which may differ on others. Site (s. It also did not include terminally ill patients transferred to palliative home care.

Further research is needed to externally validate the risk score in various settings.

The study authors noted that the risk score is the first such measure developed and validated internally for use in hospitalized HIV-positive patients. Other studies have looked at risk factors for HIV mortality. A recent study used large-scale proteomics to identify many unique proteins predicting HIV mortality.

HIV remains one of the leading causes of death worldwide, but death rates have improved with advances in treatment. A recent study found that the gap in death rates between US residents entering HIV care and those in the general population has narrowed significantly, with the life expectancy of patients diagnosed with HIV approaching. that of the general population.


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