LDH to lymphocyte percentage ratio is a novel predictor of in-hospital mortality in PLWH - a retrospective study.

BACKGROUND

Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) present significant global health challenges. Over time, the condition has evolved into a chronic disease, requiring continuous monitoring of inflammation and immune status to guide treatment strategies. This study aimed to evaluate various combinations of hematological, immunological, and biochemical parameters in PLWH with HIV/AIDS-related conditions to identify cost-effective biomarkers for predicting in-hospital mortality of people living with HIV(PLWH).

METHODS

This retrospective, observational study included 7,855 PLWH with HIV/AIDS-related admissions between 2011 and 2019. We extracted medical records and laboratory test results from the subjects. Receiver Operating Characteristic (ROC) curve analysis was performed to assess the ability of all biochemical indicators to differentiate in-hospital mortality. Extreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), and Backpropagation Neural Network (BP-NN) models were developed and evaluated, and the importance score of each feature was calculated in the optimal model. Additionally, multivariate Logistic Regression (LR) analysis and a SHAP-based (SHapley Additive exPlanations) LR model were used to compare selected indicators with key traditional variables, evaluating their predictive value for in-hospital mortality in PLWH hospitalized for HIV/AIDS-related conditions.

RESULTS

This study analyzed 46 basic biochemical parameters and 1,041 composite ratios. The Lactate Dehydrogenase to Lymphocyte Percentage Ratio (LDH to lymphocyte percentage ratio, L-LWR) achieved the highest area under the curve (AUC) of 0.716 (95% CI: 0.695–0.738, P < 0.001) in ROC analysis. In the XGBoost model, which performed best on the test set, L-LWR ranked fourth in feature importance, making it the highest-ranked biochemical indicator. Multivariate logistic regression identified clinical stage 3 (OR: 3.05, 95% CI: 1.44–6.45, P < 0.001) and high L-LWR (> 24.441) (OR: 2.55, 95% CI: 2.04–3.20, P < 0.001) as significant risk factors. In the SHAP-based LR model, high L-LWR had the most significant impact on the model’s output (P < 0.001).

CONCLUSION

L-LWR is a potential predictor of in-hospital mortality in PLWH hospitalized for HIV/AIDS-related conditions. CLINICAL TRIAL NUMBER: Not applicable.