关键词: 获得性免疫缺陷综合征, HIV, 肺炎, 社区获得性肺炎, 预后, 评分系统

Abstract: Background　Community-acquired pneumonia（CAP） is the most common opportunistic infection among people with human immunodeficiency virus（HIV）/acquired immune deficiency syndrome（AIDS）. Evaluating disease severity and scoring short-term mortality will greatly help physicians to make objective decisions during the initial visit of HIV/AIDS patients with CAP，which is crucial to patient prognosis. Objective　To develop and verify a clinical prognosis scoring system for HIV/AIDS patients with CAP. Methods　Clinical data of 615 HIV/AIDS patients with CAP（455 in modeling group，and 160 in validation group） recruited from Liuzhou People's Hospital from 2016 to 2019 were retrospectively analyzed，including demographics，underlying diseases，24-hour post-admission vital signs，clinical laboratory results（routine blood test，liver and kidney function tests，blood gas analysis），imaging examination and so on. Multivariate Logistic regression analysis of the clinical data of modeling group was conducted to screen for independent risk factors of clinical prognosis to develop a clinical prognosis scoring system. Kaplan-Meier survival analysis was used to compare the worsening mortality between different risk groups rated by the scoring system. And the predictive performance of the scoring system was tested by using the data of validation group. Results　Patients with improved and deteriorated conditions had significant differences in the prevalence of admission to the ICU，disturbance of consciousness，respiratory rate>30 breaths per minute，hypotension，platelet blood count（PLT）<100×109/L，hematocrit （HCT） <35%，pH<7.35 or >7.45，partial pressure of oxygen （PaO2） <60 mm Hg，oxygen saturation（SaO2）<93%，urea nitrogen（BUN）>7 mmol/L，lactate dehydrogenase（LDH）>230 U/L，seralbumin（ALB）<30 g/L，total bilirubin（TBil）>34.2 μmol/L，alanine aminotransferase（ALT）>40 U/L，aspartate aminotransferase（AST）>40 U/L，serum sodium（Na）<135 mmol/L or>145 mmol/L，and CD4 lymphocyte count<50 cells/mm3 （P<0.05）. Multivariate Logistic regression analysis identified 10 risk factors for prognosis: admission to the ICU，disturbance of consciousness，hypotension，PLT<100×109/L，HCT<35%，SaO2<93%，LDH>230 U/L，ALT>40 U/L，Na<135 mmol/L or >145 mmol/L and CD4 lymphocyte count <50 cells/mm3. These 10 factors were included in the prognosis scoring system and assigned the value of 6，2，1，1，2，3，1，2，2，1，respectively，and mortality risks assessed using the system were stratified into low risk（0-6 points），medium risk（7-12 points）and high risk（more than 12 points）. Kaplan- Meier survival analysis showed that the worsening mortality varied significantly across different risk groups（χ2=87.634，P<0.001）. In predicting the mortality risk，the scoring system had an AUC of 0.858 with 77.9% sensitivity and 78.4% specificity in modeling group，and had an AUC of 0.820 with 73.7% sensitivity and 77.6% specificity in validation group. Conclusion　Our clinical prognosis scoring system based on with risk factors for CAP in HIV/AIDS has been confirmed with good predictive ability.

Key words: Acquired immunodeficiency syndrome, HIV, Pneumonia, Community-acquired pneumonia, Prognosis, Scoring system