Development and external-validation of a nomogram for predicting the survival of hospitalised HIV/AIDS patients based on a large study cohort in western China

Abstract

The aim of this study was to develop and externally validate a simple-to-use nomogram for predicting the survival of hospitalised human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients (hospitalised person living with HIV/AIDS (PLWHAs)). Hospitalised PLWHAs (n = 3724) between January 2012 and December 2014 were enrolled in the training cohort. HIV-infected inpatients (n = 1987) admitted in 2015 were included as the external-validation cohort. The least absolute shrinkage and selection operator method was used to perform data dimension reduction and select the optimal predictors. The nomogram incorporated 11 independent predictors, including occupation, antiretroviral therapy, pneumonia, tuberculosis, Talaromyces marneffei, hypertension, septicemia, anaemia, respiratory failure, hypoproteinemia and electrolyte disturbances. The Likelihood χ2 statistic of the model was 516.30 (P = 0.000). Integrated Brier Score was 0.076 and Brier scores of the nomogram at the 10-day and 20-day time points were 0.046 and 0.071, respectively. The area under the curves for receiver operating characteristic were 0.819 and 0.828, and precision-recall curves were 0.242 and 0.378 at two time points. Calibration plots and decision curve analysis in the two sets showed good performance and a high net benefit of nomogram. In conclusion, the nomogram developed in the current study has relatively high calibration and is clinically useful. It provides a convenient and useful tool for timely clinical decision-making and the risk management of hospitalised PLWHAs.

A Prognostic Model to Assess Long-Term Survival of Patients on Antiretroviral Therapy: A 15-Year Retrospective Cohort Study in Southwestern China

“…This is probably because the China Free Antiretroviral Therapy Manual recommends aggressive regimens for special patients with complications and coinfection. This is consistent with a prior study in Guangxi, which reported that the diagnosis of tuberculosis was a beneficial factor for the survival of patients hospitalized HIV/AIDS [ 37 ].…”

Inappropriate data selection and statistical method lead to overestimated mortality for hospitalised HIV/AIDS patients

“…Recently, a simple-to-use nomogram for predicting the survival of hospitalised HIV/AIDS patients was published by Yuan et al . as ‘Development and external-validation of a nomogram for predicting the survival of hospitalised HIV/AIDS patients based on a large study cohort in western China’ [1]. The authors claimed the nomogram had high performance in external validation and was clinically useful.…”

“…In the paper, it said ‘The survival of the training cohort was 94.8% and 90.8% at the 10-day and 20-day, respectively’ [1], indicating the 10-day mortality is around 5% and 20-day mortality is about 9%, which are incredibly high. Compared to the numbers in the article they cited [2], the overall in-hospital mortality rate was only 29.36 per 100 person-years [2].…”

“…In the data selection process, the authors selected the latest admission for those patients with multiple admissions, thus excluded 2892 admissions (around one-third of the total admissions) [1]. However, it is obvious that death can only happen in the last admission and all the excluded previous admissions had no event.…”

Response to the letter from Dr J. Wang

“…We disagree with the authors' claim that the mortality rates in our study were incredibly high. The mortality rates at the 10-day and 20-day periods were 5.2% and 9.2%, respectively [1]; this can be compared with the overall mortality rate of hospitalised HIV/AIDS patients in the training cohort of 9.02% [1]. These rates were percentages, not person-years or person-days.…”