Clinical Characteristics Associated with Poor Prognosis of Acquired Immunodeficiency Syndrome Patients Complicated with Disseminated Talaromycosis marneffei

Figures & data

Table 1 The Demographics Clinical Manifestations of AIDS Patients Complicated with dTSM

Characteristic	Range	Total Cases (n=170)	Survival Group (n=142)	Death Group (n=28)	P-value
Male (%)		149(87.65%)	123(86.62%)	26(92.87%)	0.547*
Age (years)		37(30–46.75)	36(29–45)	43(32–52.5)	0.026
Time from onset of symptoms to visit (days)		30(14–60)	30(15–60)	30(14–30)	0.806
WBC (*10^9/L)		3.6(2.1–5.2)	3.5(2.1–5.1)	3.8(2.1–5.9)	0.684
	<4	97(57.06%)	81(57.04%)	16(57.14%)
	4–10	69(40.59%)	59(41.55%)	10(35.72%)
	>10	4(2.35%)	2(1.41%)	2(7.14%)
Neutrophil (*10^9/L)		2.7(1.6–4.2)	2.7(1.7–4.0)	3.0(1.2–5.3)	0.773
	<1.8	50(29.41%)	41(28.87%)	9(32.14%)
	1.8–6.3	103(60.59%)	89(62.68%)	14(50.00%)
	>6.3	17(10.00%)	12(8.45%)	5(17.86%)
Lymphocyte (*10^9/L)		0.3(0.2–0.5)	0.3(0.2–0.6)	0.3(0.1–0.4)	0.123
	<0.8	145(85.29%)	119(83.80%)	26(92.86%)
	0.8–3.5	23(13.53%)	22(15.49%)	1(3.57%)
	>3.5	2(1.18%)	1(0.71%)	1(3.57%)
Eosinophil (*10^9/L)		0.03(0.01–0.06)	0.03(0.01–0.07)	0.02(0.01–0.04)	0.082
	<0.05	117(68.82%)	93(65.50%)	24(85.71%)
	0.05–0.50	50(29.41%)	46(32.39%)	4(14.29%)
	>0.50	3(1.77%)	3(2.11%)	0(0.00%)
Hemoglobin (g/L)		96±20	97±20	90±22	0.083
	<60	8(4.71%)	5(3.52%)	3(10.71%)
	60–90	57(33.53%)	45(31.69%)	12(42.86%)
	91–110	61(35.88%)	55(38.73%)	6(21.43%)
	>110	44(25.88%)	37(26.06%)	7(25.00%)
Platelet (*10^9/L)		95(47–180)	109(59–191)	43(23–116)	<0.001
	<100	86(50.59%)	65(45.77%)	21(75.00%)
	≥100	84(49.41%)	77(54.23%)	7(25.00%)
CD4 count (/ul)		15(6–38)	16(6–39)	11(2–35)	0.187
	<50	138(81.18%)	114(80.28%)	24(85.71%)
	≥50	32(18.82%)	28(19.72%)	4(14.29%)
D-dimer (ug/L)		20,655(744–7512)	1667(611–5232)	8862(3415–29,921)	<0.001
	<243	12(7.06%)	12(8.45%)	0(0.00%)
	≥243	158(92.94%)	130(91.55%)	28(100.00%)
PCT (ug/L)		0.98(0.24–2.58)	0.58(0.20–1.47)	7.17(2.81–14.98)	<0.001
	<0.5	66(38.82%)	66(46.48%)	0(0.00%)
	≥0.5	104(61.18%)	76(53.52%)	28(100.00%)
ALT (U/L)		37(24–60)	36(24–60)	40(24–72)	0.674
	<40	89(52.35%)	75(52.82%)	14(50.00%)
	≥40	81(47.65%)	67(47.18%)	14(50.00%)
AST (U/L)		75(45–152)	68(41–121)	176(82–397)	<0.001
	<40	34(20.00%)	33(23.24%)	1(3.57%)
	≥40	136(80.00%)	109(76.76%)	27(96.43%)
ALB (g/L)		27.7(22.3–31.9)	28.2(24.6–32.3)	21.1(17.5–24.9)	<0.001
	<40	161(94.71%)	133(93.66%)	28(100.00%)
	≥40	9(5.29%)	9(6.34%)	0(0.00%)
Glucose (mmol/L)		5.1(4.5–5.9)	5.1(4.6–5.9)	5.2(4.0–6.3)	0.556
	<3.9	11(6.47%)	5(3.52%)	6(21.43%)
	3.9–6.1	122(71.77%)	108(76.06%)	14(50.00%)
	>6.1	37(21.76%)	29(20.42%)	8(28.57%)
BUN (mmol/L)		4.2(3.0–6.1)	3.8(2.9–4.8)	9.5(7.5–17.3)	<0.001
	<3.2	45(26.47%)	45(31.69%)	0(0.00%)
	3.2–7.1	90(52.94%)	85(59.86%)	5(17.86%)
	>7.1	35(20.59%)	12(8.45%)	23(82.14%)
LDH (U/L)		452(285–768)	414(276–652)	662(419–1650)	0.001
	<250	28(16.47%)	25(17.61%)	3(10.71%)
	≥250	142(83.53%)	117(82.39%)	25(89.29%)
CRP (mg/L)		65.5(28.1–102.2)	61.0(23.3–87.5)	98.7(41.7–146.5)	0.001
	<8	10(5.88%)	10(7.04%)	0(0.00%)
	≥8	160(94.12%)	132(92.96%)	28(100.00%)
Fever		133(78.24%)	113(79.58%)	20(71.43%)	0.340
Chills		85(50.00%)	72(50.70%)	13(46.43%)	0.679
Cough and sputum		105(61.76%)	85(59.86%)	20(71.43%)	0.250
Dyspnea		40(23.53%)	28(19.72%)	12(42.86%)	0.008
Abdominal pain and diarrhea		36(21.18%)	32(22.54%)	4(14.29%)	0.329
Dizziness and headache		20(11.76%)	16(11.27%)	4(14.29%)	0.895*
Nausea and vomiting		29(17.06%)	24(16.90%)	5(17.86%)	1.000*
Fatigue and poor appetite		106(62.35%)	93(60.49%)	13(46.43%)	0.057
Night sweat		9(5.29%)	7(4.93%)	2(7.14%)	0.987*
Lose flesh		54(31.76%)	41(28.87%)	13(46.43%)	0.068
Rash		73(42.94%)	61(42.96%)	12(42.86%)	0.992
Lymph node enlargement		157(92.35%)	130(91.55%)	27(96.43%)	0.618*
Splenomegaly		76(44.71%)	59(41.55%)	17(60.71%)	0.062
Serous membrane fluid		117(68.82%)	96(67.61%)	21(75.00%)	0.440
Shock		19(11.18%)	3(2.11%)	16(57.14%)	<0.001*
Pulmonary infection		54(31.76%)	45(31.69%)	9(32.14%)	0.962
Bacterial pneumonia		33(19.41%)	25(17.61%)	8(28.57%)	0.180
Fungal pneumonia		20(11.76%)	16(11.27%)	4(14.29%)	0.895*
Oral candidiasis		57(33.53%)	48(33.80%)	9(32.14%)	0.865
Syphilis		26(15.29%)	22(15.49%)	4(14.29%)	1.000*
Hepatitis B virus		11(6.47%)	8(5.63%)	3(10.71%)	0.563*
Tuberculosis		13(7.65%)	6(4.23%)	7(25.00%)	0.001*
PCP		36(21.18%)	29(20.42%)	7(25.00%)	0.588
Cryptococcosis		7(4.12%)	5(3.52%)	2(7.14%)	0.718*
Cytomegalovirus infection		41(24.12%)	36(25.35%)	5(17.86%)	0.397
EB virus infection		14(8.24%)	13(9.15%)	1(3.57%)	0.544*
Intestinal infection		12(7.06%)	11(7.75%)	1(3.57%)	0.700*
Antifungal therapy		165(97.06%)	141(99.30%)	24(85.71%)	<0.01**
ART		139(81.76%)	132(92.96%)	7(25.00%)	<0.001
Hospitalization time (days)		25(17–33)	27(21–34)	6(3–18)	<0.001

Notes: *By Continuity correction chi-square test. **By Fisher’s Exact Test.

Abbreviations: WBC, white blood cell; PCT, procalcitonin; ALT, alanine aminotransferase; AST, aspartate transaminase; ALB, albumin; BUN, blood urea nitrogen; LDH, lactate dehydrogenase; CRP, C-reactive protein; PCP, pneumocystis jirovecii pneumonia; ART, antiretroviral therapy.

Table 2 Logistic Regression Analysis of the Risk Factors for Death from AIDS Patients with dTSM

Variable	Univariate Analysis OR (95% CI)	P-value	Multivariate Analysis OR (95% CI)	P-value
Age (years)
<45 years old	Reference
≥45 years old	2.737(1.195–6.269)	0.017
Dyspnea
No	Reference
Yes	3.054(1.299–7.180)	0.011
Shock
No	Reference		Reference
Yes	61.778(15.747–242.358)	<0.001	28.197(1.764–450.744)	0.018
Tuberculosis
No	Reference
Yes	7.556(2.314–24.670)	0.001
Antifungal therapy
Yes	Reference
No	23.500(2.518–219.343)	<0.01
ART
Yes	Reference		Reference
No	39.600(13.583–115.452)	<0.001	61.716(5.086–748.822)	0.001
Platelet
≥100*10^9/L	Reference
<100*10^9/L	3.554(1.421–8.890)	0.007
D-dimer
<2000ug/L	Reference
≥2000ug/L	7.524(2.482–22.09)	<0.001
PCT
<2.0ug/L	Reference		Reference
≥2.0ug/L	39.000(10.919–139.296)	<0.001	7.648(1.273–45.950)	0.026
AST
<70U/L	Reference
≥70U/L	5.006(1.802–13.905)	0.002
ALB
≥25g/L	Reference
<25g/L	7.143(2.823–18.071)	<0.001
BUN
<7.1mmol/L	Reference		Reference
≥7.1mmol/L	49.833(16.040–154.819)	<0.001	56.153(4.630–681.094)	0.002
LDH
<450U/L	Reference
≥450U/L	2.962(1.224–7.168)	0.016
CRP
<60.0mg/L	Reference
≥60.0mg/L	1.995(0.846–4.709)	0.115

Abbreviations: OR, odds ratio; CI, confidence interval; ART, antiretroviral therapy; PCT, procalcitonin; AST, aspartate transaminase; ALB, albumin; BUN, blood urea nitrogen; LDH, lactate dehydrogenase; CRP, C-reactive protein.

Figure 1 Spearman correlation coefficient of four risk factors.

Abbreviations: PCT, procalcitonin; BUN, blood urea nitrogen; ART, antiretroviral therapy.

Figure 2 Nomogram model for predicting death in acquired immunodeficiency syndrome (AIDS) patients complicated with disseminated Talaromycosis marneffei (dTSM).

Figure 3 Correction curve of nomogram model for predicting death in acquired immunodeficiency syndrome (AIDS) patients complicated with disseminated Talaromycosis marneffei (dTSM).

Figure 4 Receiver operating characteristic curve (ROC) of the prediction model developed in the training (a) and validation (b) cohorts.