Multi-Clinical Factors Combined with an Artificial Intelligence Algorithm Diagnosis Model for HIV-Infected People with Bloodstream Infection

Figures & data

Figure 1 Flowchart of the diagnosis model of HIV-infected people with BSI.

Table 1 The Correlation of the Clinical Features and BSI of Individuals

Factors		BSI Negative (n=327)		BSI Positive (n=171)		P
		n	%	n	%
Gender	Male	285	87.16%	149	87.13%	0.995
	Female	42	12.84%	22	12.87%
Age	≥43	173	52.91%	68	39.77%	0.078
	<43	154	47.09%	103	60.23%
Fever	≥37.3°C	213	65.14%	130	76.02%	0.002
CD4+T (cell/mm³)	≥200	61	18.65%	11	6.43%	0.000
White blood cell (10^9/L)	≥5.05	161	49.24%	50	29.24%	0.000
Neutrophile granulocyte (10^9/L)	≥3.71	141	43.12%	51	29.82%	0.130
Hemoglobin (g/L)	≥108	216	66.06%	53	30.99%	0.000
Platelets (10^9/L)	≥182	185	56.57%	51	29.82%	0.000
Glutamic-pyruvic transaminase (U/L)	≥48	80	24.46%	49	28.65%	0.934
Albumin (g/L)	≥33.44	191	58.41%	51	29.82%	0.000
Total bilirubin (μmol/L)	≥12.78	65	19.88%	60	35.09%	0.017
Blood urea nitrogen (mmol/L)	≥4.99	91	27.83%	66	38.60%	0.004
Creatinine (μmol/L)	≥78	92	28.13%	48	28.07%	0.287
Uric acid (μmol/L)	≥253	151	46.18%	57	33.33%	0.216
Total cholesterol (mmol/l)	≥3.38	175	53.52%	51	29.82%	0.000
Creatine kinase (U/L)	≥84.59	68	20.80%	34	19.88%	0.180
Lactate dehydrogenase (U/L)	≥350	74	22.63%	77	45.03%	0.000
C-reactive protein (mg/L)	≥51.17	118	36.09%	90	52.63%	0.000
ART treatment		152	46.48%	33	19.30%	0.000
Chills		111	33.94%	80	46.78%	0.005
Cough and sputum		193	59.02%	103	60.23%	0.794
Night sweat		21	6.42%	9	5.26%	0.606
Fatigue anorexia		131	40.06%	99	57.89%	0.000
Chest tightness and shortness of breath		110	33.64%	40	23.39%	0.018
Vomiting		38	11.62%	25	14.62%	0.339
Headache dizziness		60	18.35%	34	19.88%	0.678
Diarrhea		39	11.93%	32	18.71%	0.040
Jaundice		14	4.28%	23	13.45%	0.000
Rash		68	20.80%	49	28.65%	0.049
Lymphadenectasis		209	63.91%	135	78.95%	0.001
Splenomegaly		44	13.46%	67	39.18%	0.000
Shock		9	2.75%	27	15.79%	0.000
Nodular shadow		70	21.41%	62	36.26%	0.000
Flake-like infiltrated shadow		199	60.86%	108	63.16%	0.616
Strip shadow		48	14.68%	66	38.60%	0.000
Miliary shadow		12	3.67%	11	6.43%	0.163
Hydrothorax		51	15.60%	47	27.49%	0.002
Hydropericardium		33	10.09%	48	28.07%	0.000

Notes: The P-value in bold means that the P-value is less than 0.05 and is statistically significant.

Table 2 The Distribution of Pathogenic Bacteria in HIV-Infected People with BSI (N=171)

Category	Pathogenic Bacteria	N	%
Fungus (N=119, 68.79%)	Cyanobacteria marneffei	97	56.07
	Cryptoglobus neoformans	20	11.56
	Candida albicans	2	1.16
Gram-positive bacteria (N=31, 17.92%)	Coagulase-negative staphylococcus	24	13.87
	Staphylococcus aureus	1	0.58
	Corynebacterium pseudotuberculosis	1	0.58
	Enterococcus faecalis	2	1.15
	Enterococcus faecium	1	0.58
	Arcanobacterium haemolyticum	1	0.58
	Corynebacterium stearate tuberculosis	1	0.58
Gram-negative bacterium (N=14, 8.09%)	Klebsiella pneumoniae pneumoniae	5	2.89
	Salmonella	2	1.15
	Salmonella enteritidis	2	1.15
	Salmonella typhimurium	1	0.58
	Proteus mirabilis	1	0.58
	Escherichia coli	1	0.58
	Campylobacter fetus	1	0.58
	Bacteroides fragilis	1	0.58
Mycobacteria (N=9, 5.2%)	Mycobacterium tuberculosis	8	4.62
	Mycobacterium avium	1	0.58

Table 3 Multivariate Analysis of BSI in HIV-Infected People

Factors	OR	P	95% CI
			Low	High
Gender	0.999	0.549	0.826	1.208
Age	0.998	0.781	0.574	1.734
Hemoglobin	0.966	0.000	0.953	0.98
Platelets	0.996	0.019	0.993	0.999
CD4+T cell	0.997	0.026	0.994	1.000
Blood urea nitrogen	1.079	0.035	1.005	1.158
Lactate dehydrogenase	1.002	0.000	1.001	1.003
ART treatment	3.632	0.000	2.345	5.626
Splenomegaly	2.515	0.004	1.345	4.702
Shock	3.846	0.022	1.211	12.217
Nodular shadow	2.173	0.007	1.242	3.802
Strip shadow	3.924	0.000	2.176	7.074

Table 4 The ROC Analysis of the Risk Factors of HIV-Infected People with BSI

Factors	AUC	P	95% CI
			Low	High
Hemoglobin	0.742	0.000	0.210	0.306
CD4+T cell	0.703	0.000	0.246	0.348
Platelets	0.690	0.000	0.256	0.363
LDH	0.638	0.000	0.583	0.694
Splenomegaly	0.638	0.000	0.582	0.695
ART treatment	0.637	0.000	0.310	0.415
Strip shadow	0.628	0.000	0.571	0.684
Blood urea nitrogen	0.591	0.001	0.535	0.648
Nodular shadow	0.577	0.008	0.520	0.633
Shock	0.566	0.025	0.508	0.623

Table 5 The Baseline Information of Training Set and Validation Set

Factors		HIV People with Negative BSI (n=327)				P	HIV People with Positive BSI (n=171)				P
		Training Set (n=262)		Testing Set (n=65)			Training Set (n=137)		Testing Set (n=34)
		N	%	N	%		N	%	N	%
Gender	Female	229	87.40%	56	86.15%	0.788	121	88.32%	28	82.35%	0.355
	Male	33	12.60%	9	13.85%		16	11.68%	6	17.65%
Age	≥43	134	51.15%	39	60.00%	0.816	56	40.88%	16	47.06%	0.556
	<43	128	48.85%	26	40.00%		81	59.12%	18	52.94%
Fever (°C)	≥37.3	170	64.89%	43	66.15%	0.401	109	79.56%	21	61.76%	0.061
	<37.3	92	35.11%	22	33.85%		28	20.44%	13	38.24%
CD4+T (cell/mm³)	≥200	44	16.79%	17	26.15%	0.736	9	6.57%	2	5.88%	0.911
	<200	218	83.21%	48	73.85%		128	93.43%	32	94.12%
White blood cell (10^9/L)	≥5.05	108	41.22%	29	44.62%	0.415	36	26.28%	14	41.18%	0.354
	<5.05	154	58.78%	36	55.38%		101	73.72%	120	352.94%
Neutrophile granulocyte (10^9/L)	≥3.71	109	41.60%	32	49.23%	0.391	37	27.01%	14	41.18%	0.187
	<3.71	153	58.40%	33	50.77%		100	72.99%	20	58.82%
Hemoglobin (g/L)	≥108	172	65.65%	44	67.69%	0.677	43	31.39%	10	29.41%	0.374
	<108	90	34.35%	21	32.31%		94	68.61%	24	70.59%
Platelets (10^9/L)	≥182	142	54.20%	38	58.46%	0.983	35	25.55%	16	47.06%	0.091
	<182	120	45.80%	27	41.54%		102	74.45%	18	52.94%
Glutamic-pyruvic transaminase (U/L)	≥48	64	24.43%	16	24.62%	0.397	37	27.01%	12	35.29%	0.415
	<48	198	75.57%	49	75.38%		100	72.99%	22	64.71%
Albumin (g/L)	≥33.44	156	59.54%	35	53.85%	0.564	44	32.12%	7	20.59%	0.067
	<33.44	106	40.46%	30	46.15%		93	67.88%	27	79.41%
Total bilirubin (μmol/L)	≥12.78	47	17.94%	18	27.69%	0.915	48	35.04%	12	35.29%	0.772
	<12.78	215	82.06%	47	72.31%		89	64.96%	22	64.71%
Blood urea nitrogen (mmol/L)	≥4.99	192	73.28%	26	40.00%	0.175	52	37.96%	14	41.18%	0.646
	<4.99	70	26.72%	39	60.00%		85	62.04%	20	58.82%
Creatinine (μmol/L)	≥78	74	28.24%	28	43.08%	0.394	37	27.01%	12	35.29%	0.981
	<78	188	71.76%	37	56.92%		100	72.99%	22	64.71%
Uric acid (μmol/L)	≥253	116	44.27%	35	53.85%	0.529	46	33.58%	11	32.35%	0.578
	<253	146	55.73%	30	46.15%		91	66.42%	23	67.65%
Total cholesterol (mmol/l)	≥3.38	140	53.44%	35	53.85%	0.301	38	27.74%	13	38.24%	0.756
	<3.38	122	46.56%	30	46.15%		99	72.26%	21	61.76%
Creatine kinase (U/L)	≥84.59	56	21.37%	12	18.46%	0.952	27	19.71%	7	20.59%	0.84
	<84.59	206	78.63%	53	81.54%		110	80.29%	27	79.41%
Lactate dehydrogenase (U/L)	≥350	57	21.76%	17	26.15%	0.211	60	43.80%	17	50.00%	0.329
	<350	105	40.08%	48	73.85%		77	56.20%	17	50.00%
C-reactive protein (mg/L)	≥51.17	92	35.11%	26	40.00%	0.544	74	54.01%	16	47.06%	0.875
	<51.17	170	64.89%	32	49.23%		63	45.99%	18	52.94%
Lymphadenectasis	+	174	66.41%	35	53.85%	0.071	109	79.56%	26	76.47%	0.488
	−	88	33.59%	30	46.15%		28	20.44%	8	23.53%
Splenomegaly	+	34	12.98%	10	15.38%	0.620	56	40.88%	11	32.35%	0.266
	−	227	86.64%	55	84.62%		81	59.12%	23	67.65%
ART treatment	+	122	46.56%	30	46.15%	0.953	25	18.25%	8	23.53%	0.554
	−	140	53.44%	35	53.85%		112	81.75%	26	76.47%
Chills	+	90	34.35%	21	32.31%	0.756	67	48.91%	13	38.24%	0.501
	−	172	65.65%	44	67.69%		70	51.09%	21	61.76%
Cough and sputum	+	151	57.63%	42	64.62%	0.301	81	59.12%	22	64.71%	0.612
	−	111	42.37%	23	35.38%		56	40.88%	12	35.29%
Night sweat	+	16	6.11%	5	7.69%	0.642	8	5.84%	1	2.94%	0.357
	−	246	93.89%	60	92.31%		129	94.16%	33	97.06%
Fatigue anorexia	+	110	41.98%	21	32.31%	0.145	78	56.93%	21	61.76%	0.221
	−	152	58.02%	44	67.69%		59	43.07%	13	38.24%
Chest tightness and shortness of breath	+	87	33.21%	23	35.38%	0.740	30	21.90%	10	29.41%	0.401
	−	175	66.79%	42	64.62%		107	78.10%	24	70.59%
Vomiting	+	35	13.36%	3	4.62%	0.061	22	16.06%	3	8.82%	0.506
	−	227	86.64%	62	95.38%		115	83.94%	31	91.18%
Headache dizziness	+	44	16.79%	16	24.62%	0.185	29	21.17%	5	14.71%	0.597
	−	218	83.21%	49	75.38%		108	78.83%	29	85.29%
Diarrhea	+	33	12.60%	6	9.23%	0.455	27	19.71%	5	14.71%	0.694
	−	229	87.40%	59	90.77%		110	80.29%	29	85.29%
Rash	+	55	20.99%	13	20.00%	0.860	38	27.74%	11	32.35%	0.357
	−	207	79.01%	52	80.00%		99	72.26%	23	67.65%
Shock	+	5	1.91%	4	6.15%	0.178	20	14.60%	7	20.59%	0.394
	−	257	98.09%	61	93.85%		117	85.40%	27	79.41%
Nodular shadow	+	59	22.52%	11	16.92%	0.298	48	35.04%	14	41.18%	0.508
	−	203	77.48%	54	83.08%		89	64.96%	20	58.82%
Flake-like infiltrated shadow	+	159	60.69%	40	61.54%	0.900	80	58.39%	28	82.35%	0.083
	−	103	39.31%	25	38.46%		57	41.61%	6	17.65%
Strip shadow	+	42	16.03%	6	9.23%	0.114	47	34.31%	19	55.88%	0.471
	−	220	83.97%	59	90.77%		90	65.69%	15	44.12%
Miliary shadow	+	10	3.82%	2	3.08%	0.777	8	5.84%	3	8.82%	0.528
	−	252	96.18%	63	96.92%		129	94.16%	31	91.18%
Hydrothorax	+	42	16.03%	9	13.85%	0.995	35	25.55%	12	35.29%	0.257
	−	220	83.97%	56	86.15%		102	74.45%	22	64.71%
Hydropericardium	+	28	10.69%	5	7.69%	0.665	37	27.01%	11	32.35%	0.537
	−	234	89.31%	60	92.31%		100	72.99%	23	67.65%
Jaundice	+	10	3.82%	4	6.15%		17	12.41%	6	17.65%	0.426
	−	252	96.18%	61	93.85%		120	87.59%	28	82.35%

Figure 2 Evaluation of the diagnosis power of the 12 factors combined AI Algorithm in HIV-infected people with BSI. (A). ROC curves of the 12-factor-based optimal models constructed by the eight algorithms in the training and (B). Testing datasets. (C). ROC curves of the 12-factor-based “svmRadial” model in testing datasets, AUC=0.916. (D). The evaluation indicators of the 12-factor-based“svmRadial”model diagnosis efficacy.