Predicting the Risk of in-Hospital Mortality in Patients with HIV-Associated Talaromyces Marneffei Infection

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DOI: 10.21522/TIJAR.2014.09.03.Art003

Authors : Thanh Nguyen Tat, Dat Nguyen Tat


Disseminated Talaromyces marneffei infection (formerly termed penicilliosis) is the third most common microbiologically confirmed opportunistic infection in Southeast Asia, with mortality of up to 30% despite antifungal therapy. There are restrictive clinical algorithms to predict treatment outcomes. A total of 513 patients with microbiology-confirmed HIV-associated talaromycosis were included in the analysis. Poor outcome was observed in 143/513 patients (27.9%). In the univariate logistic regression analysis, hepatomegaly and splenomegaly were protective factors. Shorter duration of illness, higher respiratory rates, dyspnea, AIDS-associated central nervous system syndromes, platelet counts <50,000 cells/mL, aspartate transaminase (AST) >300 U/L, alanine transaminase (ALT) >150 U/L, serum creatinine >110 µmol/L were predictors of poor outcome. In the multivariate logistic regression analysis, shorter days of illness, higher respiratory rates, platelet counts <50,000 cells/mL, AST >300 U/L and serum creatinine >110 µmol/L, active tuberculosis (TB) and/or ongoing TB induction treatment and AIDS-associated central nervous system syndromes were independent predictors of poor outcome. The prognostic scores ranged from 0 to 19, corresponding to a mortality risk of 0% to 100%. The internal validation showed acceptable discrimination (AUC=0.68) and calibration slope (0.93). The Brier score for model performance was 0.14. We developed a simple scoring system that can predict the risk of death in patients with HIV-associated talaromycosis based on routinely measured characteristics on admission. The scoring system will be further externally validated using other cohorts in the region.
Keywords: Talaromyces marneffei, Invasive fungal infections, Mortality, Prognostic model, Vietnam.


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