Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort.
Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort.
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DOI：
10.1093/mmy/myab005
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发表时间：
2021-04-06
期刊：
影响因子：
2.9
通讯作者：
Le T
中科院分区：
文献类型：
--
作者：
Klus J;Ly VT;Chan C;Le T
距菌病是东南亚艾滋病相关机会性感染和死亡的主要原因。我们最近在伊曲康唑与两性霉素治疗塔拉霉菌病(IVAP)试验中显示，两性霉素B诱导治疗在24周内降低了死亡率，但在前两周不能。在真实环境中的抗真菌治疗效果还没有得到严格的评估。使用从越南胡志明市热带病医院2004-2009年的患者记录中获得的数据，我们首先开发了一个使用贝叶斯Logistic回归的预后模型，以确定死亡的预测因素。其次，我们开发了一个使用倾向评分匹配的因果模型来评估两性霉素B和伊曲康唑的治疗效果。我们的预后模型确定静脉吸毒(优势比[OR]=22.01)、较高的呼吸率(OR=61.12)、较高的绝对淋巴细胞计数(OR=61.62)、并发呼吸道感染(OR=1.67)或中枢神经系统感染(OR=2.66)是死亡的独立预测因素。发热(OR=0.56)是保护性因素。我们的预测模型表现出良好的样本内性能和样本外验证，识别率分别为0.85和0.91。我们的因果模型显示两性霉素B和伊曲康唑在前两周的治疗结果没有显著差异(95%可信区间：0.62，2.50)。我们的预后模型提供了一个简单的工具，基于常规收集的临床数据来预测个别患者的预后。我们的因果模型在2周时显示了与IVAP试验类似的结果，表明了真实世界数据和临床试验数据之间的一致性。
Talaromycosis is a leading cause of AIDS-associated opportunistic infections and death in Southeast Asia. We have recently shown in the Itraconazole versus Amphotericin for Talaromycosis (IVAP) trial that induction therapy with amphotericin B reduced mortality over 24 weeks, but not during the first 2 weeks. Antifungal treatment effects in real-world settings have not been rigorously evaluated. Using data obtained from patient records at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam from 2004 to 2009, we first developed a prognostic model using Bayesian logistic regression to identify predictors of death. Second, we developed a causal model using propensity score matching to assess the treatment effects of amphotericin B and itraconazole. Our prognostic model identified intravenous drug use (odds ratio [OR] = 2.01), higher respiratory rate (OR = 1.12), higher absolute lymphocyte count (OR = 1.62), a concurrent respiratory infection (OR = 1.67) or central nervous system infection (OR = 2.66) as independent predictors of death. Fever (OR = 0.56) was a protective factor. Our prognostic model exhibits good in-sample performance and out-of-sample validation, with a discrimination power of 0.85 and 0.91, respectively. Our causal model showed no significant difference in treatment outcomes between amphotericin B and itraconazole over the first 2 weeks (95% credible interval: 0.62, 2.50). Our prognostic model provides a simple tool based on routinely collected clinical data to predict individual patient outcome. Our causal model shows similar results to the IVAP trial at 2 weeks, demonstrating an agreement between real-world data and clinical trial data.
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影响因子：
2
作者：
Rubin, Donald B.
通讯作者：
Rubin, Donald B.
影响因子：
158.5
作者：
Thuy Le;Nguyen Van Kinh;Wolbers, Marcel
通讯作者：
Wolbers, Marcel
影响因子：
5
作者：
Son, V. T.;Khue, P. M.;Strobel, M.
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Strobel, M.
影响因子：
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作者：
Ranjana, KH;Priyokumar, K;Chakrabarti, A
通讯作者：
Chakrabarti, A
DOI：
10.1016/j.trstmh.2011.10.004
发表时间：
2012-01-01
影响因子：
2.2
作者：
Tran Vu Thieu Nga;Parry, Christopher M.;Baker, Stephen
通讯作者：
Baker, Stephen