Abstract
BackgroundThis study aims to evaluate specific risk factors influencing prognosis of HIV-infected patients with toxoplasma encephalitis (TE) in order to develop a prognostic risk scoring system for them.MethodsThis is a six-center retrospective study of hospitalized HIV/TE patients. Data including six-week mortality after diagnosis, baseline characteristics, clinical features, laboratory tests and radiological characteristics of eligible patients were assimilated for risk model establishing.ResultsIn this study, the six-week mortality among 94 retrospective cases was 11.7% (11/94). Seven specific risk factors, viz. time from symptom onset to presentation, fever, dizziness, CD4+ T-cell counts, memory deficits, patchy brain lesions, and disorders of consciousness were calculated to be statistically associated with mortality. A criterion value of ‘9’ was selected as the optimal cut-off value of the established model. The AUC of the ROC curve of this scoring model was 0.976 (p < 0.001). The sensitivity and specificity of the risk scoring model was 100.0 and 86.9%, respectively, which were 81.8 and 94.1% of this scoring model in the verification cohort, respectively.ConclusionsThe developed scoring system was established with simple risk factors, which also allows expeditious implementation of accurate prognostication, and appropriate therapeutic interventions in HIV-infected patients with TE.
Highlights
This study aims to evaluate specific risk factors influencing prognosis of Human immunodeficiency virus (HIV)-infected patients with toxoplasma encephalitis (TE) in order to develop a prognostic risk scoring system for them
In HIV-infected patients, seropositivity for Toxoplasma antibodies is as high as 10–40%, and it is estimated that a third of those patients will eventually progress to toxoplasma encephalitis (TE) [2], in those with CD4+ T-cell counts
One hundred fifty-six HIV-infected patients admitted to hospital from May 2013 to September 2019, and diagnosed with TE were eligible to participate in the present study
Summary
This study aims to evaluate specific risk factors influencing prognosis of HIV-infected patients with toxoplasma encephalitis (TE) in order to develop a prognostic risk scoring system for them. Previous studies have reported on potential predictors of poor prognosis of central nervous system toxoplasmosis. Independent risk factors for death among HIV-infected patients with TE were acute kidney injury (AKI) and hyponatremia [5]. CD4+ T-cell counts and Glasgow Coma Scale (GCS) scores were independently associated with poor outcome (modified Rankin Scale > 2) in HIV-infected patients with severe cerebral. It is apparent that there have been studies considering factors related to the risk of poor prognosis in TE, and that the reported factors are not specific, and are mainly restricted to specific laboratory tests. There is at present no risk stratification scoring model for TE among HIV-infected patients designed to prognosticate outcomes. The development of a user-friendly scoring model with clear outcome prognostication benefit, and a favorable predictive value, is urgently needed
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