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Abstract：
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.
RESULTS: 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).
CONCLUSIONS: 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.
BACKGROUND: National Institute of Health Fogarty International Center.
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.
RESULTS: 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).
CONCLUSIONS: 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.
BACKGROUND: National Institute of Health Fogarty International Center.
摘要：
背景：为感染艾滋病毒的儿童和青少年提供差异化服务（DSD）可以改善有针对性的资源使用。我们得出了死亡率预测评分，以指导HIV感染儿童和青少年的临床决策。
方法：这项回顾性观察性队列研究的数据被评估为所有感染艾滋病毒并开始抗逆转录病毒治疗（ART）的儿童和青少年;年龄0-19岁;并在埃斯瓦蒂尼的贝勒诊所注册，马拉维,莱索托,坦桑尼亚,和乌干达在2005年至2020年之间。临床预测数据，包括人体测量值,体检,ART,世卫组织阶段，和实验室检查在ART开始时进行。进行反向逐步变量选择和逻辑回归，以建立ART开始后1年内死亡率的预测模型。产生了死亡的可能性，与真实结果相比，内部验证，并根据世卫组织高级艾滋病毒标准进行评估。
结果：研究人群包括2005年5月18日至2020年12月18日期间接受ART的16958名感染艾滋病毒的儿童和青少年。最准确模型的预测变量包括：年龄，CD4百分比，白细胞计数,血红蛋白浓度，血小板计数,和BMIZ评分作为连续变量，和WHO临床分期和水肿，异常肌张力和呼吸窘迫检查为分类变量。预测模型的曲线下面积（AUC）在训练集中为0·851（95％CI0·839-0·863），在测试集中为0·822（0·800-0·845），与WHOHIV高级标准的0·606（0·595-0·617）相比（p<0·0001）。
结论：这项研究评估了一个大的，多国人口为感染艾滋病毒的儿童和青少年得出死亡率预测工具。该模型比WHO先进的HIV标准更准确地预测临床结果，并且有可能改善高负担环境中HIV感染儿童和青少年的DSD。
背景：国家卫生研究所福格蒂国际中心。
方法：这项回顾性观察性队列研究的数据被评估为所有感染艾滋病毒并开始抗逆转录病毒治疗（ART）的儿童和青少年;年龄0-19岁;并在埃斯瓦蒂尼的贝勒诊所注册，马拉维,莱索托,坦桑尼亚,和乌干达在2005年至2020年之间。临床预测数据，包括人体测量值,体检,ART,世卫组织阶段，和实验室检查在ART开始时进行。进行反向逐步变量选择和逻辑回归，以建立ART开始后1年内死亡率的预测模型。产生了死亡的可能性，与真实结果相比，内部验证，并根据世卫组织高级艾滋病毒标准进行评估。
结果：研究人群包括2005年5月18日至2020年12月18日期间接受ART的16958名感染艾滋病毒的儿童和青少年。最准确模型的预测变量包括：年龄，CD4百分比，白细胞计数,血红蛋白浓度，血小板计数,和BMIZ评分作为连续变量，和WHO临床分期和水肿，异常肌张力和呼吸窘迫检查为分类变量。预测模型的曲线下面积（AUC）在训练集中为0·851（95％CI0·839-0·863），在测试集中为0·822（0·800-0·845），与WHOHIV高级标准的0·606（0·595-0·617）相比（p<0·0001）。
结论：这项研究评估了一个大的，多国人口为感染艾滋病毒的儿童和青少年得出死亡率预测工具。该模型比WHO先进的HIV标准更准确地预测临床结果，并且有可能改善高负担环境中HIV感染儿童和青少年的DSD。
背景：国家卫生研究所福格蒂国际中心。
