{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:44:05Z","timestamp":1788871445663,"version":"build-2803163510"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T00:00:00Z","timestamp":1651622400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81971934"],"award-info":[{"award-number":["81971934"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Guangxi Bagui Scholar"},{"name":"Guangxi Science Fund for Distinguished Young Scholars","award":["2018GXNSFFA281001"],"award-info":[{"award-number":["2018GXNSFFA281001"]}]},{"name":"Guangxi Medical University Training Program for Distinguished Young Scholars"},{"name":"Guangxi Natural Science Foundation of Guangxi","award":["2021GXNSFBA196004"],"award-info":[{"award-number":["2021GXNSFBA196004"]}]},{"DOI":"10.13039\/501100017691","name":"Guangxi Key Research and Development Plan","doi-asserted-by":"crossref","award":["GuikeAB18050022"],"award-info":[{"award-number":["GuikeAB18050022"]}],"id":[{"id":"10.13039\/501100017691","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the Nanning Science and Technology Major Project","award":["20193008"],"award-info":[{"award-number":["20193008"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p><jats:italic>Talaromycosis<\/jats:italic> is a serious regional disease endemic in Southeast Asia. In China, <jats:italic>Talaromyces marneffei (T. marneffei)<\/jats:italic> infections is mainly concentrated in the southern region, especially in Guangxi, and cause considerable in-hospital mortality in HIV-infected individuals. Currently, the factors that influence in-hospital death of HIV\/AIDS patients with <jats:italic>T<\/jats:italic>. <jats:italic>marneffei<\/jats:italic> infection are not completely clear. Existing machine learning techniques can be used to develop a predictive model to identify relevant prognostic factors to predict death and appears to be essential to reducing in-hospital mortality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We prospectively enrolled HIV\/AIDS patients with <jats:italic>talaromycosis<\/jats:italic> in the Fourth People\u2019s Hospital of Nanning, Guangxi, from January 2012 to June 2019. Clinical features were selected and used to train four different machine learning models (logistic regression, XGBoost, KNN, and SVM) to predict the treatment outcome of hospitalized patients, and 30% internal validation was used to evaluate the performance of models. Machine learning model performance was assessed according to a range of learning metrics, including area under the receiver operating characteristic curve (AUC). The SHapley Additive exPlanations (SHAP) tool was used to explain the model.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 1927 HIV\/AIDS patients with <jats:italic>T<\/jats:italic>. <jats:italic>marneffei<\/jats:italic> infection were included. The average in-hospital mortality rate was 13.3% (256\/1927) from 2012 to 2019. The most common complications\/coinfections were pneumonia (68.9%), followed by oral candida (47.5%), and tuberculosis (40.6%). Deceased patients showed higher CD4\/CD8 ratios, aspartate aminotransferase (AST) levels, creatinine levels, urea levels, uric acid (UA) levels, lactate dehydrogenase (LDH) levels, total bilirubin levels, creatine kinase levels, white blood-cell counts (WBC) counts, neutrophil counts, procaicltonin levels and C-reactive protein (CRP) levels and lower CD3<jats:sup>+<\/jats:sup> T-cell count, CD8<jats:sup>+<\/jats:sup> T-cell count, and lymphocyte counts, platelet (PLT), high-density lipoprotein cholesterol (HDL), hemoglobin (Hb) levels than those of surviving patients. The predictive XGBoost model exhibited 0.71 sensitivity, 0.99 specificity, and 0.97 AUC in the training dataset, and our outcome prediction model provided robust discrimination in the testing dataset, showing an AUC of 0.90 with 0.69 sensitivity and 0.96 specificity. The other three models were ruled out due to poor performance. Septic shock and respiratory failure were the most important predictive features, followed by uric acid, urea, platelets, and the AST\/ALT ratios.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The XGBoost machine learning model is a good predictor in the hospitalization outcome of HIV\/AIDS patients with <jats:italic>T<\/jats:italic>. <jats:italic>marneffei<\/jats:italic> infection. The model may have potential application in mortality prediction and high-risk factor identification in the <jats:italic>talaromycosis<\/jats:italic> population.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010388","type":"journal-article","created":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T17:39:45Z","timestamp":1651685985000},"page":"e0010388","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":33,"title":["Machine learning-based in-hospital mortality prediction of HIV\/AIDS patients with Talaromyces marneffei infection in Guangxi, China"],"prefix":"10.1371","volume":"16","author":[{"given":"Minjuan","family":"Shi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianyan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wudi","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqin","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirun","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueqi","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongfeng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zongxiang","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingmei","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiegang","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingyu","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiman","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4905-9348","authenticated-orcid":true,"given":"Junjun","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,5,4]]},"reference":[{"issue":"6","key":"pntd.0010388.ref001","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s11046-019-00410-2","article-title":"Talaromycosis (Penicilliosis) Due to Talaromyces (Penicillium) marneffei: Insights into the Clinical Trends of a Major Fungal Disease 60 Years After the Discovery of the Pathogen","volume":"184","author":"C Cao","year":"2019","journal-title":"Mycopathologia"},{"issue":"1","key":"pntd.0010388.ref002","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1742-6405-9-24","article-title":"Clinical characteristics and outcome of Penicillium marneffei infection among HIV-infected patients in northern Vietnam","volume":"9","author":"M Larsson","year":"2012","journal-title":"AIDS research and therapy"},{"issue":"1","key":"pntd.0010388.ref003","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1186\/s12879-020-05260-8","article-title":"Burden of Talaromyces marneffei infection in people living with HIV\/AIDS in Asia during ART era: a systematic review and meta-analysis","volume":"20","author":"Y Qin","year":"2020","journal-title":"BMC infectious diseases"},{"issue":"6","key":"pntd.0010388.ref004","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1007\/s10096-017-2927-6","article-title":"Serious fungal infections in Thailand","volume":"36","author":"M Chayakulkeeree","year":"2017","journal-title":"European journal of clinical microbiology & infectious diseases: official publication of the European Society of Clinical Microbiology"},{"issue":"2","key":"pntd.0010388.ref005","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.cmi.2018.04.018","article-title":"Effects of Talaromyces marneffei infection on mortality of HIV\/AIDS patients in southern China: a retrospective cohort study","volume":"25","author":"J Jiang","year":"2019","journal-title":"Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases"},{"issue":"11","key":"pntd.0010388.ref006","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1111\/hiv.13024","article-title":"Clinical epidemiology and outcome of HIV-associated talaromycosis in Guangdong, China, during 2011\u20132017","volume":"21","author":"RS Ying","year":"2020","journal-title":"HIV medicine"},{"key":"pntd.0010388.ref007","article-title":"The decreased number and function of lymphocytes is associated with Penicillium marneffei infection in HIV-negative patients","author":"F Hu","year":"2020","journal-title":"Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi"},{"key":"pntd.0010388.ref008","doi-asserted-by":"crossref","first-page":"e01055","DOI":"10.1016\/j.idcr.2021.e01055","article-title":"Rapid diagnosis of Talaromyces marneffei infection assisted by metagenomic next-generation sequencing in a HIV-negative patient","volume":"23","author":"J Zhang","year":"2021","journal-title":"IDCases"},{"issue":"1","key":"pntd.0010388.ref009","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1186\/s12879-018-3276-5","article-title":"Rapid and precise diagnosis of disseminated T.marneffei infection assisted by high-throughput sequencing of multifarious specimens in a HIV-negative patient: a case report","volume":"18","author":"YM Zhu","year":"2018","journal-title":"BMC infectious diseases"},{"issue":"3","key":"pntd.0010388.ref010","first-page":"e19","article-title":"Talaromyces (Penicillium) marneffei infection in non-HIV-infected patients","volume":"5","author":"JF Chan","year":"2016","journal-title":"Emerging microbes & infections"},{"issue":"1\u20132","key":"pntd.0010388.ref011","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s11046-012-9577-0","article-title":"Penicillium marneffei infection: an emerging disease in mainland China","volume":"175","author":"Y Hu","year":"2013","journal-title":"Mycopathologia"},{"issue":"6","key":"pntd.0010388.ref012","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.4269\/ajtmh.16-0521","article-title":"Clinical Characteristics and Prognosis of Penicilliosis Among Human Immunodeficiency Virus-Infected Patients in Eastern China","volume":"96","author":"J Chen","year":"2017","journal-title":"The American journal of tropical medicine and hygiene"},{"issue":"11\u201312","key":"pntd.0010388.ref013","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.medmal.2014.09.008","article-title":"Penicilliosis and AIDS in Haiphong, Vietnam: evolution and predictive factors of death","volume":"44","author":"VT Son","year":"2014","journal-title":"Medecine et maladies infectieuses"},{"key":"pntd.0010388.ref014","article-title":"The Global Distribution, Drivers, and Burden of Talaromycosis 1964\u20132017","author":"C Ning","year":"2020","journal-title":"DuKeHeath"},{"issue":"11","key":"pntd.0010388.ref015","doi-asserted-by":"crossref","first-page":"e1618","DOI":"10.1016\/S2214-109X(21)00350-8","article-title":"A global call for talaromycosis to be recognised as a neglected tropical disease","volume":"9","author":"S Narayanasamy","year":"2021","journal-title":"The Lancet Global health"},{"issue":"9","key":"pntd.0010388.ref016","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.3201\/eid2609.200016","article-title":"Risk-Based Estimate of Human Fungal Disease Burden, China","volume":"26","author":"LH Zhou","year":"2020","journal-title":"Emerg Infect Dis"},{"issue":"3","key":"pntd.0010388.ref017","article-title":"Epidenmiological characteristic of HIV\/AIDS in Guangxi Zhuang Autonomous Region, 2010\u20132017","volume":"40","author":"D Xianmin","year":"2019","journal-title":"Chin J Epidemiol 2019"},{"issue":"3","key":"pntd.0010388.ref018","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1111\/j.1468-3083.2011.04429.x","article-title":"Mucocutaneous manifestations of HIV-infected patients in the era of HAART in Guangxi Zhuang Autonomous Region, China","volume":"27","author":"J Han","year":"2013","journal-title":"Journal of the European Academy of Dermatology and Venereology: JEADV"},{"key":"pntd.0010388.ref019","doi-asserted-by":"crossref","first-page":"692329","DOI":"10.3389\/fonc.2021.692329","article-title":"Machine-Learning-Derived Nomogram Based on 3D Radiomic Features and Clinical Factors Predicts Progression-Free Survival in Lung Adenocarcinoma","volume":"11","author":"G Liu","year":"2021","journal-title":"Frontiers in oncology"},{"key":"pntd.0010388.ref020","doi-asserted-by":"crossref","first-page":"749459","DOI":"10.3389\/fimmu.2021.749459","article-title":"A Machine Learning Model to Predict the Triple Negative Breast Cancer Immune Subtype","volume":"12","author":"Z Chen","year":"2021","journal-title":"Frontiers in immunology"},{"key":"pntd.0010388.ref021","doi-asserted-by":"crossref","first-page":"104594","DOI":"10.1016\/j.ijmedinf.2021.104594","article-title":"Predicting prognosis in COVID-19 patients using machine learning and readily available clinical data","volume":"155","author":"TW Campbell","year":"2021","journal-title":"International journal of medical informatics"},{"issue":"6","key":"pntd.0010388.ref022","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1093\/ije\/dyaa171","article-title":"Early prediction of mortality risk among patients with severe COVID-19, using machine learning","volume":"49","author":"C Hu","year":"2021","journal-title":"International journal of epidemiology"},{"key":"pntd.0010388.ref023","doi-asserted-by":"crossref","first-page":"142810","DOI":"10.1016\/j.scitotenv.2020.142810","article-title":"Identifying novel factors associated with COVID-19 transmission and fatality using the machine learning approach","volume":"764","author":"M Li","year":"2021","journal-title":"The Science of the total environment"},{"issue":"12","key":"pntd.0010388.ref024","doi-asserted-by":"crossref","first-page":"e0008960","DOI":"10.1371\/journal.pntd.0008960","article-title":"Assessing the risk of dengue severity using demographic information and laboratory test results with machine learning","volume":"14","author":"SW Huang","year":"2020","journal-title":"PLoS neglected tropical diseases"},{"key":"pntd.0010388.ref025","volume-title":"Tuberculosis","year":"2006"},{"key":"pntd.0010388.ref026","volume-title":"Internal medicine","year":"2013","edition":"8"},{"key":"pntd.0010388.ref027","volume-title":"Neurology","year":"2013","edition":"7"},{"key":"pntd.0010388.ref028","volume-title":"Infectious diseases","year":"2013","edition":"8"},{"issue":"3","key":"pntd.0010388.ref029","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1620\/tjem.244.231","article-title":"Prevalence of Opportunistic Infections and Causes of Death among Hospitalized HIV-Infected Patients in Sichuan, China","volume":"244","author":"W Pang","year":"2018","journal-title":"The Tohoku journal of experimental medicine"},{"issue":"8","key":"pntd.0010388.ref030","doi-asserted-by":"crossref","first-page":"e0181519","DOI":"10.1371\/journal.pone.0181519","article-title":"A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa","volume":"12","author":"Y Hanifa","year":"2017","journal-title":"PloS one"},{"key":"pntd.0010388.ref031","doi-asserted-by":"crossref","first-page":"e84","DOI":"10.1017\/S0950268820000758","article-title":"Development and external-validation of a nomogram for predicting the survival of hospitalised HIV\/AIDS patients based on a large study cohort in western China","volume":"148","author":"Z Yuan","year":"2020","journal-title":"Epidemiology and infection"},{"issue":"4","key":"pntd.0010388.ref032","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1093\/mmy\/myab005","article-title":"Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort","volume":"59","author":"J Klus","year":"2021","journal-title":"Medical mycology"},{"issue":"7","key":"pntd.0010388.ref033","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1093\/cid\/cir028","article-title":"Epidemiology, seasonality, and predictors of outcome of AIDS-associated Penicillium marneffei infection in Ho Chi Minh City, Viet Nam","volume":"52","author":"T Le","year":"2011","journal-title":"Clinical infectious diseases: an official publication of the Infectious Diseases Society of America"},{"issue":"8","key":"pntd.0010388.ref034","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1089\/aid.2015.0271","article-title":"Causes of Death Among Patients Infected with HIV at a Tertiary Care Hospital in China: An Observational Cohort Study","volume":"32","author":"J Xiao","year":"2016","journal-title":"AIDS research and human retroviruses"},{"issue":"2","key":"pntd.0010388.ref035","doi-asserted-by":"crossref","first-page":"191","DOI":"10.5858\/2004-128-191-CSOHPM","article-title":"Clinicopathologic study of hepatic Penicillium marneffei in Northern Thailand","volume":"128","author":"A Yousukh","year":"2004","journal-title":"Archives of pathology & laboratory medicine"},{"key":"pntd.0010388.ref036","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1186\/1471-2334-13-464","article-title":"Clinical and laboratory characteristics of penicilliosis marneffei among patients with and without HIV infection in Northern Thailand: a retrospective study","volume":"13","author":"R Kawila","year":"2013","journal-title":"BMC infectious diseases"},{"issue":"5","key":"pntd.0010388.ref037","first-page":"541","article-title":"AST to ALT Ratio is elevated in disseminated histoplasmosis as compared to localized pulmonary disease and other endemic mycoses","volume":"55","author":"A Spec","year":"2017","journal-title":"Medical mycology"}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010388","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,4]],"date-time":"2022-05-04T17:40:36Z","timestamp":1651686036000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010388"}},"subtitle":[],"editor":[{"given":"Roderick","family":"Hay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,5,4]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0010388","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,4]]}}}