抗病毒治疗HIV/AIDS患者列线图建立及验证

Development and validation of a prognostic nomogram for HIV/AIDS patients with antiretroviral therapy

目的针对接受抗逆转录病毒治疗的HIV/AIDS患者建立有效的列线图并验证,准确预测HIV/AIDS患者的死亡风险。方法所有数据均来自中国艾滋病防治信息系统新疆维吾尔自治区2006—2019年的数据。通过基于建模组的单因素和多因素Cox比例风险回归分析来确定列线图中纳入的因子,在建模组(3272人)与验证组(1636人)中均使用受试者工作特征曲线下面积(AUC-ROC)和校准曲线评估列线图的预测准确性,使用决策曲线分析(DCA)、x-tile分析和Kaplan-Meier曲线评估列线图的临床实用性。结果根据多因素Cox比例风险回归确定独立的预后因素包括血红蛋白、体质指数(BMI)、性别、谷草转氨酶、WHO分期、延迟时间和CD4细胞,以此建立了列线图模型。列线图模型在建模组的AUC-ROC为0.781(95%CI=0.703~0.861),在验证组的AUC-ROC为0.829(95%CI=0.758~0.896),在预测生存率的校准曲线中可以观察到列线图预测与实际观察之间一致性良好。此外,根据列线图得分,将研究对象分为3个不同的(低、中、高)风险组,以预测不同组患者生存率。结论列线图可以为接受抗逆转录病毒疗法的HIV/AIDS患者提供准确和有利的预测。

Objective To establish and verify a nomogram for accurately predicting the mortality risk of human immunodeficency virus/acquired immunodeficiency syndrome(HIV/AIDS)patients receiving antiretroviral therapy(ART).Methods From China Information System for AIDS Prevention and Control,we extracted the data on HIV/AIDS patients registered during the period from 2006 through 2019 in Xinjiang Uygur Autonomous Region.Univariate and multivariate Cox proportional hazard regression analysis were carried out for the data on 3272 HIV/AIDS patients of modeling group to determine the factors to be included in the nomogram.The area under the receiver-operating characteristics curve(AUCROC)and calibration curve were adopted to assess the prediction accuracy of the established nomogram for the data of modeling group and verifying group(1636 HIV/AIDS patients).Decision curve analysis(DCA),x-tile analysis and Kaplan-Meier curve were used to evaluate the clinical utility of the established nomogram.Results Based on the results of multivariate Cox proportional hazard regression analysis,the established nomogram model included following independent factors for predicting the prognosis of HIV/AIDS patients with ART:hemoglobin,body mass index,gender,aspartate aminotransferase,disease staging according to criterions proposed by World Health Organization,delay time between HIV infection and ART,and CD4 cell count.The AUC-ROC of the established nomogram is 0.781(95%confidence interval[95%CI]:0.703–0.861)for the modeling group and that for the verification group is 0.829(95%CI:0.758–0.896).The calibration curve for the survival of the patients during the 3-year period demonstrated a good consistency between the survival rate predicted by the nomogram and that observed actually.The survival rate was predicted based on the established nomogram for the patients at different(low,moderate and high)risk of mortality assessed according to nomogram scoring resulted from the analysis.Conclusion The study established a nomogram which could provide accurate and meaningful predictions for the survival of the HIV/AIDS patients with antiretroviral therapy.