Skip to content
1887

Journal of Medical Microbiology logo Journal of Medical Microbiology

Volume 74, Issue 9

Enhancing mortality prediction in AIDS and disseminated : the impact of novel inflammatory markers in a nomogram Open Access

Abstract

(TM) is a common opportunistic infection among patients with AIDS, characterized by rapid systemic dissemination and a high mortality rate. Early identification of patients at risk of death is critical to improving clinical outcomes.

Despite the severity of disseminated TM infection (DPSM), few predictive tools exist to assess mortality risk in affected AIDS patients. A clinical prediction model incorporating novel inflammatory markers may help guide timely intervention.

This study aimed to identify independent risk factors for mortality in AIDS patients with DPSM and to develop and validate a nomogram for individualized risk prediction.

A retrospective study was conducted on 174 AIDS patients with DPSM and complete clinical data admitted to Hangzhou Xixi Hospital between January 2013 and June 2024. A training cohort of 104 patients was used to identify mortality-related risk factors via logistic regression and to construct a predictive nomogram. The remaining 70 patients constituted a validation cohort to evaluate the model using area under the curve (AUC), decision curve analysis (DCA) and calibration curves.

The overall mortality rate was 18.97% (33/174). Effusion, bone marrow suppression, systemic inflammation and malnutrition were significantly associated with fatal outcomes (<0.05). Multivariate logistic regression identified white blood cell count, C-reactive protein-to-prealbumin ratio and procalcitonin-to-albumin ratio as independent risk factors for mortality. The nomogram based on these predictors showed strong discriminative power in both training and validation cohorts (AUC=0.89 and 0.78, respectively). DCA demonstrated the clinical utility and net benefit of the model.

This study identified key predictors of mortality in AIDS patients with DPSM and developed a validated nomogram incorporating novel inflammatory markers. The tool offers potential value for individualized risk assessment and clinical decision-making.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): AIDS , bone marrow suppression , C-reactive protein-to-prealbumin ratio , disseminated Talaromyces marneffei and procalcitonin-to-albumin ratio
Funding
This study was supported by the:
  • Hangzhou Biomedical and Health Industry Development Support Technology Special Project (Award 2023WJC193)
    • Principal Award Recipient: YanZhang
© 2025 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.002066
2025-09-05
2025-12-05

Metrics

Loading full text...

Full text loading...

/deliver/fulltext/jmm/74/9/jmm002066.html?itemId=/content/journal/jmm/10.1099/jmm.0.002066&mimeType=html&fmt=ahah

References

  1. Cao C, Xi L, Chaturvedi V. Talaromycosis (Penicilliosis) Due to Talaromyces (Penicillium) marneffei: insights into the clinical trends of a major fungal disease 60 years after the discovery of the pathogen. Mycopathologia 2019; 184:709–720 [View Article] [PubMed]
     [Google Scholar]
  2. Pruksaphon K, Nosanchuk JD, Ratanabanangkoon K, Youngchim S. Talaromyces marneffei Infection: virulence, intracellular lifestyle and host defense mechanisms. J Fungi 2022; 8:200 [View Article] [PubMed]
     [Google Scholar]
  3. Qiu Y, Zhang J-Q, Pan M-L, Zeng W, Tang S-D et al. Determinants of prognosis in Talaromyces marneffei infections with respiratory system lesions. Chin Med J 2019; 132:1909–1918 [View Article] [PubMed]
     [Google Scholar]
  4. Chan JFW, Lau SKP, Yuen K-Y, Woo PCY. Talaromyces (Penicillium) marneffei infection in non-HIV-infected patients. Emerg Microbes Infect 2016; 5:e19 [View Article] [PubMed]
     [Google Scholar]
  5. Liu X, Xing H, Lin J, Sun J, Wang Y. Coexisting of primary central nervous system Lymphoma and Talaromyces marneffei brain abscess in an AIDS patient, a case report and review of the literature. Infect Drug Resist 2024; 17:709–718 [View Article]
     [Google Scholar]
  6. Wang F, Han R, Chen S. An overlooked and underrated endemic mycosis-talaromycosis and the pathogenic fungus Talaromyces marneffei. Clin Microbiol Rev 2023; 36:e0005122 [View Article] [PubMed]
     [Google Scholar]
  7. Chastain DB, Henao-Martínez AF, Franco-Paredes C. Opportunistic Invasive Mycoses in AIDS: cryptococcosis, histoplasmosis, coccidiodomycosis, and talaromycosis. Curr Infect Dis Rep 2017; 19:36 [View Article] [PubMed]
     [Google Scholar]
  8. Chen L, Yu L, Wu Y, Ming W-K, Huang Z et al. A 52-year-old man with an 11-month history of fever, cough, chest pain, pleural effusion, and left lung atelectasis. Chest 2020; 158:e153–e157 [View Article] [PubMed]
     [Google Scholar]
  9. Centers for Disease Control and Prevention (CDC) Revised surveillance case definition for HIV infection--united states, 2014. MMWR Recomm Rep 2014; 63:1–10
     [Google Scholar]
  10. Xin Q, Xie T, Chen R, Wang H, Zhang X et al. Construction and validation of an early warning model for predicting the acute kidney injury in elderly patients with sepsis. Aging Clin Exp Res 2022; 34:2993–3004 [View Article] [PubMed]
     [Google Scholar]
  11. Zhang Y, Gu K, Du W, Xu A. Risk factors and prediction model for mortality in HIV/Talaromyces marneffei co-infection: A retrospective cohort study. Heliyon 2024; 10:e32560 [View Article]
     [Google Scholar]
  12. Kawila R, Chaiwarith R, Supparatpinyo K. Clinical and laboratory characteristics of penicilliosis marneffei among patients with and without HIV infection in Northern Thailand: a retrospective study. BMC Infect Dis 2013; 13:464 [View Article] [PubMed]
     [Google Scholar]
  13. Shen Q, Sheng L, Zhang J, Ye J, Zhou J. Analysis of clinical characteristics and prognosis of talaromycosis (with or without human immunodeficiency virus) from a non-endemic area: a retrospective study. Infection 2022; 50:169–178 [View Article] [PubMed]
     [Google Scholar]
  14. Qiu Y, Zeng W, Zhang H, Zhong X, Tang S et al. Comparison of pleural effusion features and biomarkers between talaromycosis and tuberculosis in non-human immunodeficiency virus-infected patients. BMC Infect Dis 2019; 19:745 [View Article] [PubMed]
     [Google Scholar]
  15. Karcher DS, Frost AR. The bone marrow in human immunodeficiency virus (HIV)-related disease. Morphology and clinical correlation. Am J Clin Pathol 1991; 95:63–71 [View Article] [PubMed]
     [Google Scholar]
  16. Wang M, Dong X, Wan H, Zhang B, Yu L et al. Characteristics and risk factors for death in HIV-positive talaromycosis marneffei patients with sepsis. Heliyon 2024; 10:e34024 [View Article]
     [Google Scholar]
  17. Zeng Q, Jin Y, Yin G, Yang D, Li W et al. Peripheral immune profile of children with Talaromyces marneffei infections: a retrospective analysis of 21 cases. BMC Infect Dis 2021; 21:287 [View Article] [PubMed]
     [Google Scholar]
  18. Karimi A, Shobeiri P, Kulasinghe A, Rezaei N. Novel systemic inflammation markers to predict COVID-19 prognosis. Front Immunol 2021; 12:741061 [View Article] [PubMed]
     [Google Scholar]
  19. Huang Z, Cai P, Zhao Y, Niu D, Xu F et al. Preoperative C-reactive protein to prealbumin ratio is independently associated with prognosis in patients with resectable colorectal cancer. J Surg Oncol 2022; 125:1238–1250 [View Article] [PubMed]
     [Google Scholar]
  20. Tan M, Lu Y, Jiang H, Zhang L. The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: a systematic review and meta-analysis. J Cell Biochem 2019; 120:5852–5859 [View Article] [PubMed]
     [Google Scholar]
  21. Chen L, Wu X, Qin H, Zhu H. The PCT to albumin ratio predicts mortality in patients with acute kidney injury caused by abdominal infection-evoked sepsis. Front Nutr 2021; 8:584461 [View Article]
     [Google Scholar]
  22. Xie Q, Zhou Y, Xu Z, Yang Y, Kuang D et al. The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury. BMC Nephrol 2011; 12:30 [View Article] [PubMed]
     [Google Scholar]
  23. Sedgwick P. Retrospective cohort studies: advantages and disadvantages. BMJ 2014; 348:g1072 [View Article]
     [Google Scholar]
  24. Kaji AH, Schriger D, Green S. Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies. Ann Emerg Med 2014; 64:292–298 [View Article] [PubMed]
     [Google Scholar]
  25. Vassar M, Holzmann M. The retrospective chart review: important methodological considerations. J Educ Eval Health Prof 2013; 10:12 [View Article] [PubMed]
     [Google Scholar]
/content/journal/jmm/10.1099/jmm.0.002066
Loading
Enhancing mortality prediction in AIDS and disseminated Talaromyces marneffei: the impact of novel inflammatory markers in a nomogram
J. Med. Microbiol. 74, 002066 (2025); https://doi.org/10.1099/jmm.0.002066
/content/journal/jmm/10.1099/jmm.0.002066
/content/journal/jmm/10.1099/jmm.0.002066
Loading

Data & Media loading...

Supplements

Supplementary material 1

PDF

Supplementary material 2

EXCEL

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An error occurred
Approval was partially successful, following selected items could not be processed due to error