Alexander Kay, Bhekumusa Lukhele, Sandile Dlamini, Abigail Seeger, Phumzile Dlamini, Sandile Ndabezitha, Nobuhle Mthethwa, Teresa Steffy, Lilian Komba, Pauline Amuge, Eunice Ketangenyi, Peter Elyanu, Adamson Munthali, Amos Msekandiana, Yvonne Maldonado, Elizabeth Chiao, Adeodata Kekitiinwa, Lineo Thahane, Lumumba Mwita, H Lester Kirchner, Anna Maria Mandalakas
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We derived a mortality prediction score to guide clinical decision making for children and adolescents living with HIV.</p><p><strong>Methods: </strong>Data for this retrospective observational cohort study were evaluated for all children and adolescents living with HIV and initiating antiretroviral therapy (ART); aged 0-19 years; and enrolled at Baylor clinics in Eswatini, Malawi, Lesotho, Tanzania, and Uganda between 2005 and 2020. Data for clinical prediction, including anthropometric values, physical examination, ART, WHO stage, and laboratory tests were captured at ART initiation. Backward stepwise variable selection and logistic regression were performed to develop predictive models for mortality within 1 year of ART initiation. Probabilities of mortality were generated, compared with true outcomes, internally validated, and evaluated against WHO advanced HIV criteria.</p><p><strong>Findings: </strong>The study population included 16 958 children and adolescents living with HIV and initiated on ART between May 18, 2005, and Dec 18, 2020. Predictive variables for the most accurate model included: age, CD4 percentage, white blood cell count, haemoglobin concentration, platelet count, and BMI Z score as continuous variables, and WHO clinical stage and oedema, abnormal muscle tone and respiratory distress on examination as categorical variables. The area under the curve (AUC) of the predictive model was 0·851 (95% CI 0·839-0·863) in the training set and 0·822 (0·800-0·845) in the test set, compared with 0·606 (0·595-0·617) for the WHO advanced HIV criteria (p<0·0001).</p><p><strong>Interpretation: </strong>This study evaluated a large, multinational population to derive a mortality prediction tool for children and adolescents living with HIV. 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引用次数: 0
摘要
背景：为感染艾滋病病毒的儿童和青少年提供差异化服务（DSD）可提高资源使用的针对性。我们得出了一个死亡率预测评分，用于指导儿童和青少年艾滋病感染者的临床决策：这项回顾性观察队列研究的数据评估对象为 2005 年至 2020 年期间在埃斯瓦提尼、马拉维、莱索托、坦桑尼亚和乌干达贝勒诊所登记的所有感染艾滋病毒并开始接受抗逆转录病毒疗法（ART）的 0-19 岁儿童和青少年。临床预测数据包括人体测量值、体格检查、抗逆转录病毒疗法、世卫组织分期以及抗逆转录病毒疗法启动时的实验室检测。通过逆向逐步变量选择和逻辑回归，建立了抗逆转录病毒疗法启动后 1 年内的死亡率预测模型。生成的死亡率概率与真实结果进行了比较、内部验证，并根据世卫组织艾滋病高级标准进行了评估：研究对象包括 16 958 名感染 HIV 的儿童和青少年，他们在 2005 年 5 月 18 日至 2020 年 12 月 18 日期间开始接受抗逆转录病毒疗法。最准确模型的预测变量包括：作为连续变量的年龄、CD4 百分比、白细胞计数、血红蛋白浓度、血小板计数和体重指数 Z 值，以及作为分类变量的世卫组织临床分期、水肿、肌张力异常和呼吸困难。在训练集中，预测模型的曲线下面积（AUC）为 0-851（95% CI 0-839-0-863），在测试集中为 0-822（0-800-0-845），而 WHO 高级 HIV 标准为 0-606（0-595-0-617）（p解释：这项研究对一个大型的多国人群进行了评估，为感染艾滋病病毒的儿童和青少年设计了一种死亡率预测工具。该模型比 WHO 高级 HIV 标准更准确地预测了临床结果，并有可能改善高负担环境中感染 HIV 的儿童和青少年的 DSD：美国国立卫生研究院福加蒂国际中心。
Predicting mortality within 1 year of ART initiation in children and adolescents living with HIV in sub-Saharan Africa: a retrospective observational cohort study.
Background: Differentiated service delivery (DSD) for children and adolescents living with HIV can improve targeted resource use. We derived a mortality prediction score to guide clinical decision making for children and adolescents living with HIV.
Methods: Data for this retrospective observational cohort study were evaluated for all children and adolescents living with HIV and initiating antiretroviral therapy (ART); aged 0-19 years; and enrolled at Baylor clinics in Eswatini, Malawi, Lesotho, Tanzania, and Uganda between 2005 and 2020. Data for clinical prediction, including anthropometric values, physical examination, ART, WHO stage, and laboratory tests were captured at ART initiation. Backward stepwise variable selection and logistic regression were performed to develop predictive models for mortality within 1 year of ART initiation. Probabilities of mortality were generated, compared with true outcomes, internally validated, and evaluated against WHO advanced HIV criteria.
Findings: The study population included 16 958 children and adolescents living with HIV and initiated on ART between May 18, 2005, and Dec 18, 2020. Predictive variables for the most accurate model included: age, CD4 percentage, white blood cell count, haemoglobin concentration, platelet count, and BMI Z score as continuous variables, and WHO clinical stage and oedema, abnormal muscle tone and respiratory distress on examination as categorical variables. The area under the curve (AUC) of the predictive model was 0·851 (95% CI 0·839-0·863) in the training set and 0·822 (0·800-0·845) in the test set, compared with 0·606 (0·595-0·617) for the WHO advanced HIV criteria (p<0·0001).
Interpretation: This study evaluated a large, multinational population to derive a mortality prediction tool for children and adolescents living with HIV. The model more accurately predicted clinical outcomes than the WHO advanced HIV criteria and has the potential to improve DSD for children and adolescents living with HIV in high-burden settings.
Funding: National Institute of Health Fogarty International Center.
期刊介绍：
The Lancet Global Health is an online publication that releases monthly open access (subscription-free) issues.Each issue includes original research, commentary, and correspondence.In addition to this, the publication also provides regular blog posts.
The main focus of The Lancet Global Health is on disadvantaged populations, which can include both entire economic regions and marginalized groups within prosperous nations.The publication prefers to cover topics related to reproductive, maternal, neonatal, child, and adolescent health; infectious diseases (including neglected tropical diseases); non-communicable diseases; mental health; the global health workforce; health systems; surgery; and health policy.
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