Email this article Predicting COVID-19 outcomes in patients at advanced stages of HIV infection: a model-based approach
- Authors: Tsygankova A.E.1, Chulanov V.P.1, Gerasimov A.N.2, Volchkova E.V.1, Privalenko A.A.2, Bakhtina V.A.3, Khabudaev V.A.4, Baimukhambetova D.V.1
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Affiliations:
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
- Central Research Institute of Epidemiology
- Specialized Clinical Infectious Hospital
- Irkutsk Regional Clinical Hospital
- Issue: Vol 29, No 1 (2024)
- Pages: 5-17
- Section: ORIGINAL STUDIES
- URL: https://journals.rcsi.science/1560-9529/article/view/254332
- DOI: https://doi.org/10.17816/EID627198
- ID: 254332
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Abstract
BACKGROUND: Today, clinicians and their decisions extensively rely on specific treatment algorithms. These algorithms include prognostic models to identify high risk patients requiring hospital admission and clinical monitoring. This study suggests a prognostic model for forecasting COVID-19 outcomes in patients with advanced HIV infection, considering the high risk of unfavorable outcomes and the need for a specialized approach.
AIM: To develop a prognostic model that combines predictors of unfavorable COVID-19 outcomes in patients with advanced HIV infection.
MATERIALS AND METHODS: The study was based on 500 medical records of patients with advanced HIV infection admitted for confirmed COVID-19 between March 1, 2020, and December 31, 2022, and inpatient treatment at the Infectious Diseases Hospital in Moscow.
RESULTS: All 500 patients were evaluated for 167 predictive markers for unfavorable COVID-19 outcomes, outlining 50 indicators that significantly varied across the subgroups of patients with both advanced HIV infection and COVID-19 depending on the presence of favorable or poor outcomes. Oxygen therapy was the most significant factor showing a strong correlation with poor outcomes in patients with advanced HIV infection and COVID-19. Subsequently, predictors were selected stepwise to enhance the predictive accuracy of the resulting model by adding more factors.
The resulting model included seven factors: oxygen therapy requirements, CD4+ count under 50 cells/μL; manifested CMV infection with lung damage; elevated levels of lactate dehydrogenase, urea, and fibrinogen; and the presence of unspecified encephalitis. Using the available data in the calculations, a prognostic scenario and a receiver operating characteristic (ROC) curve were created to assess the practical significance of the proposed prognostic model. The area under the ROC curve was 90.9%, confirming the prediction accuracy and overall practical significance of the model.
CONCLUSIONS: The proposed prognostic model enables the assessment of potential outcomes and planning of adequate therapies in patients with HIV and COVID-19 co-infection admitted to hospitals at advanced stages of the disease.
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##article.viewOnOriginalSite##About the authors
Anna E. Tsygankova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Author for correspondence.
Email: anna.tsygankova.inf@gmail.com
ORCID iD: 0000-0003-3766-1868
SPIN-code: 6583-0476
ResearcherId: HDM-3718-2022
MD
Russian Federation, 8 Trubetskaya street, 119048 MoscowVladimir P. Chulanov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: vladimir.chulanov@rcvh.ru
ORCID iD: 0000-0001-6303-9293
SPIN-code: 2336-4545
MD, Dr. Sci. (Med.), Professor
Russian Federation, 8 Trubetskaya street, 119048 MoscowAndrey N. Gerasimov
Central Research Institute of Epidemiology
Email: andr-gerasim@yandex.ru
ORCID iD: 0000-0003-4549-7172
SPIN-code: 4742-1459
Scopus Author ID: 141741
Dr. Sci. (Phys.-Math.), Associate Professor
Russian Federation, MoscowElena V. Volchkova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: antononina@rambler.ru
ORCID iD: 0000-0003-4581-4510
SPIN-code: 3342-4681
MD, Dr. Sci. (Med.), Professor
Russian Federation, 8 Trubetskaya street, 119048 MoscowAnton A. Privalenko
Central Research Institute of Epidemiology
Email: antochka001@mail.ru
ORCID iD: 0009-0001-4827-1673
medical statistician
Russian Federation, MoscowViktoriya A. Bakhtina
Specialized Clinical Infectious Hospital
Email: dom-167@mail.ru
ORCID iD: 0000-0001-6065-2922
SPIN-code: 9446-5319
MD, Cand. Sci. (Med.)
Russian Federation, KrasnodarVladimir A. Khabudaev
Irkutsk Regional Clinical Hospital
Email: ioikb@ioikb.ru
MD, Cand. Sci. (Med.)
Russian Federation, IrkutskDina V. Baimukhambetova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: dbaimukhambietova@bk.ru
ORCID iD: 0000-0002-5518-9301
SPIN-code: 9039-7431
6th year student
Russian Federation, 8 Trubetskaya street, 119048 MoscowReferences
- Royal College of Physicians. National Early Warning Score (NEWS): Standardising the assessment of acuteillness severity in the NHS. London: RCP; 2012.
- Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020;81(2):e16–e25. doi: 10.1016/j.jinf.2020.04.021
- Zhou Y, Zhang Z, Tian J, Xiong S. Risk factors associated with disease progression in a cohort of patients infected with the 2019 novel coronavirus. Ann Palliat Med. 2020;9(2):428–436. doi: 10.21037/apm.2020.03.26
- Vremennye metodicheskie rekomendatsii. Profilaktika, diagnostika i lechenie novoi koronavirusnoi infektsii (COVID-19). Versii 3–18. Ministerstvo zdravookhraneniya Rossiiskoi Federatsii. [Internet]. (In Russ). Available at: https://minzdrav.gov.ru/ministry/med_covid19.
- Wynants L, Van Calster B, Collins GS, et al. Prediction models for diagnosis and prognosis of COVID-19: systematic review and critical appraisal. BMJ. 2020;369:m1328. doi: 10.1136/bmj.m1328
- Prikaz Ministerstva zdravookhraneniya Rossiiskoi Federatsii ot 9 noyabrya 2012 g. № 758n “Ob utverzhdenii standarta spetsializirovannoi meditsinskoi pomoshchi pri bolezni, vyzvannoi virusom immunodefitsita cheloveka (VICh-infektsii)” [Internet]. (In Russ). Available at: https://minzdrav.gov.ru/documents/8837-prikaz-ministerstva-zdravoohraneniya-rossiyskoy-federatsii-ot-9-noyabrya-2012-g-758n-ob-utverzhdenii-standarta-spetsializirovannoy-meditsinskoy-pomoschi-pri-bolezni-vyzvannoy-virusom-immunodefitsita-cheloveka-vich-infektsii.
- Gerasimov AN, Morozova NI. Parametric and Nonparametric Methods in Medical Statistics. Epidemiology and Vaccinal Prevention. 2015;14(5):6–12. (In Russ). doi: 10.31631/2073-3046-2015-14-5-6-12
- Chen R, Liang W, Jiang M, et al. Risk Factors of Fatal Outcome in Hospitalized Subjects With Coronavirus Disease 2019 From a Nationwide Analysis in China. Chest. 2020;158(1):97–105. doi: 10.1016/j.chest.2020.04.010
- Nagibina MV, Smirnov NA, Bessarab TP, et al. Analysis of the course and outcomes of COVID-19 in HIV infected patients according to the infectious diseases’ hospital of Moscow. Clinical Medicine (Russian Journal). 2023;101(2-3):93–100. (In Russ). doi: 10.30629/0023-2149-2023-101-2-3-93-100
- Dandachi D, Geiger G, Montgomery MW, et al. Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients With Human Immunodeficiency Virus and Coronavirus Disease 2019. Clin Infect Dis. 2021;73(7):e1964–e1972. doi: 10.1093/cid/ciaa1339
- Yendewa GA, Perez JA, Schlick K, Tribout H, McComsey GA. Clinical Features and Outcomes of Coronavirus Disease 2019 Among People With Human Immunodeficiency Virus in the United States: A Multicenter Study From a Large Global Health Research Network (TriNetX). Open Forum Infect Dis. 2021;8(7):ofab272. doi: 10.1093/ofid/ofab272
- Danwang C, Noubiap JJ, Robert A, Yombi JC. Outcomes of patients with HIV and COVID-19 co-infection: a systematic review and meta-analysis. AIDS Res Ther. 2022;19(1):3. doi: 10.1186/s12981-021-00427-y
- Geretti AM, Stockdale AJ, Kelly SH, et al. Outcomes of Coronavirus Disease 2019 (COVID-19) Related Hospitalization Among People With Human Immunodeficiency Virus (HIV) in the ISARIC World Health Organization (WHO) Clinical Characterization Protocol (UK): A Prospective Observational Study. Clin Infect Dis. 2021;73(7): e2095–e2106. doi: 10.1093/cid/ciaa1605
- Kassanjee R, Davies MA, Ngwenya O, et al. COVID-19 among adults living with HIV: correlates of mortality among public sector healthcare users in Western Cape, South Africa. J Int AIDS Soc. 2023;26(6):e26104. doi: 10.1002/jia2.26104
- Sun J, Jiang R, Shao Y, et al. Antiretroviral therapy-naïve people living with HIV tend to have more severe symptoms of COVID-19. Chin Med J (Engl). 2023;136(22):2753–2755. doi: 10.1097/CM9.0000000000002902
- Marmorino F, Salvatore L, Barbara C, et al. Serum LDH predicts benefit from bevacizumab beyond progression in metastatic colorectal cancer. Br J Cancer. 2017;116(3):318–323. doi: 10.1038/bjc.2016.413
- Lu J, Wei Z, Jiang H, et al. Lactate dehydrogenase is associated with 28-day mortality in patients with sepsis: a retrospective observational study. J Surg Res. 2018;228:314–321. doi: 10.1016/j.jss.2018.03.035
- Gulhar R, Ashraf MA, Jialal I. Physiology, Acute Phase Reactants. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available at: http://www.ncbi.nlm.nih.gov/books/NBK519570.
- Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5): 377–382. doi: 10.1136/thorax.58.5.377
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