Construction and validation of a nomogram to predict mortality risk in HIV/AIDS patients undergoing maintenance hemodialysis

Abstract

Objective: This study was aimed to explore the death risk factors in HIV/AIDS patients undergoing maintenance hemodialysis, and constructed a mortality prediction risk model. Methods: In this study, we retrospectively collected clinical data of HIV/AIDS patients who received hemodialysis in Chengdu Public Health Clinical Medical Center between June 6,2017 and June 6,2023, and were divided into survival group and mortality group on the basis of the follow-up result. Besides, we separated all patients into training set, which was used for model construction, and validation set for model verification according to 8:2 ratio. The t-test, non-parametric test, chi-square test, fisher’s precise test and ROC analysis were used for variable selection, and the logistic regression analysis was used for exploring the relationship between variables and death. And then, we used the stepwise logistic regression to construct a mortality risk prediction model in HIV/AIDS patients undergoing maintenance hemodialysis, and next, we used R software to visualize the prediction model which called a nomogram. And last, ROC analysis, calibration curve and decision curve were used for model evaluation, and meanwhile, we used a independent internal validation set for model verification. Result: In this study, we collected clinical data of 166 HIV/AIDS patients undergoing maintenance hemodialysis, including 123 patients in the training set(55 mortalities and 68 survivals)and 43 patients in the validation set(20mortalities and 23survivals). Stepwise Logistic regression showed that education level [OR(95%CI): 3.754 (1.247-11.300), p=0.019], dialysis age after diagnosis of HIV/AIDS [OR(95%CI):0.050 (0.013-0.187),p=0.000], creatine kinase isoenzyme (CK-MB)[OR(95%CI): 7.666 (2.237-26.271),p=0.001],neutrophil and lymphocyte counts ratio (NLR)[OR(95%CI):3.864 (1.266-11.795),p=0.018], magnesium (Mg²⁺)[OR(95%CI): 4.883 (1.479-16.118),p=0.009],HIV-RNA[OR(95%CI): 17.616 (3.797-81.721),p=0.000] were independent risk factors of HIV/AIDS patients undergoing hemodialysis, and afterwards, we constructed a nomogram based on the 6 independent risk factors. The AUC of the prediction model in ROC analysis was0.921 (95%CI 0.883~0.968), indicating that this nomogram had a good efficacy in predicting mortality. In addition, the calibration curve and decision curve both showed that the nomogram had good clinical application. Futhermore, there was a same result in the validation set. Conclusion: In present study, the nomogram model had a good performance in predicting the mortality of HIV/AIDS patients undergoing maintenance hemodialysis, which is worth promoting in clinical practice.