A novel personalised mortality risk prediction tool for HIV-associated cryptococcal meningitis could lead to future treatment stratification trials - less intensive regimens for less unwell patients? Our new manuscript.
www.thelancet.com/journals/lan...
#IDsky #HIV #GlobalHealth #meningitis #fungal
Many thanks to all our co-authors on the paper for all their hard work and support!
8/8
The Periskope-CM models accurately predict mortality risk in patients with HIV-associated CM and show promise as a tool to direct future treatment stratification trials. They are available to use for research purposes at the following link: www.periskope.org/cm/
7/8
Explorative analysis of treatment effect demonstrated a trend towards improved outcomes in patients with low predicted risk who received the single high dose liposomal amphotericin B, compared with standard amphotericin B deoxycholate + flucytosine.
6/8
Calibration, the measure of how well model predictions matched observed events, was reasonable for both regression models, although demonstrated some overprediction of risk at high-risk ranges, where training data was sparser. The machine learning model demonstrated miscalibration.
5/8
Both regression models discriminated well between patients who met the outcome and those who did not in held out validation data. The machine learning model did not improve performance.
4/8
We developed multivariable logistic regression models to predict 2-week mortality on data from the ACTA www.nejm.org/doi/full/10.... and Ambition www.nejm.org/doi/full/10.... trials using best-practice methods, comparing them head-to-head with a machine learning model trained on the same data.
3/8
Cryptococcal meningitis (CM) is a major driver of global HIV-related deaths. Treatment is intensive and toxic, so stratifying patients by disease severity may allow for more targeted therapy – less intensive regimens for less unwell patients.
2/8
Very excited to share our new piece of work in the Lancet Global Health @lancetgh.bsky.social – Periskope-CM, a set of personalised risk prediction tools for HIV-associated cryptococcal meningitis mortality: www.thelancet.com/journals/lan...
#IDsky #HIV #GlobalHealth #meningitis #fungal
1/8
Many thanks to all our co-authors on the paper for all their hard work and support!
8/8
The Periskope-CM models accurately predict mortality risk in patients with HIV-associated CM and show promise as a tool to direct future treatment stratification trials. They are available to use for research purposes at the following link: www.periskope.org/cm/
7/8
Explorative analysis of treatment effect demonstrated a trend towards improved outcomes in patients with low predicted risk who received the single high dose liposomal amphotericin B, compared with standard amphotericin B deoxycholate + flucytosine.
6/8
Calibration, the measure of how well model predictions matched observed events, was reasonable for both regression models, although demonstrated some overprediction of risk at high-risk ranges, where training data was sparser. The machine learning model demonstrated miscalibration.
5/8
Both regression models discriminated well between patients who met the outcome and those who did not in held out validation data. The machine learning model did not improve performance.
4/8
We developed multivariable logistic regression models to predict 2-week mortality on data from the ACTA www.nejm.org/doi/full/10.... and Ambition www.nejm.org/doi/full/10.... trials using best-practice methods, comparing them head-to-head with a machine learning model trained on the same data.
3/8
Cryptococcal meningitis (CM) is a major driver of global HIV-related deaths. Treatment is intensive and toxic, so stratifying patients by disease severity may allow for more targeted therapy – less intensive regimens for less unwell patients.
2/8
Fantastic piece of work by @richarddriley.bsky.social and others - this is the next step we need to be taking when we report the performance of clinical prediction models.
New research article in The Lancet Microbe
Assessment of MpoxPlex, a high-throughput and multiplexed immunoassay: a diagnostic accuracy study
www.thelancet.com/journals/lan...
#IDSky #ClinMicro #ViroSky #Mpox #OpenAccess #OA
🆕💫 Analysis of AMBITION RCT
Individuals started ART w/in 2 wks before presenting with cryptococcal meningitis, presumably active cryptococcal infection, have higher mortality, whereas those presenting on ART for > =2 wks have a more favorable prognosis #idsky
academic.oup.com/cid/advance-...
Interesting to #IDSky & #ClinMicro
Ever wonder about the basis for fear-mongering & conspiracy theories about mRNA vax? Wish you had a place to go when someone cites "proof"?
I've got you covered! In my latest @plos.org I buckle up for the waves of anti-vax muck likely to come in 2025. 1/2
absolutelymaybe.plos.org/2024/12/28/g...
Great piece in the Lancet Microbe from colleagues at HTD and RIPL about the vaccinating for dengue in travellers! 👏🏻
www.thelancet.com/journals/lan...
Full details of how to go about it all for Uk travellers in the excellent Green Book travelhealthpro.org.uk/media_lib/ml...
#IDSky #ViroSky
Potential delivery of some antibiotics too?
Clearly there may be some significant issues with volume of fluid to be delivered subcutaneously!
#OPAT #IDSky #clinmicro #AMR
Fatal Case of Crimean-Congo Hemorrhagic Fever, Portugal, 2024
#IDSky #EpiSky
Our letter about HLH in murine typhus has just been published in the Journal of Infection! doi.org/10.1016/j.ji.... Many thanks to my co-authors, with a special mention to Sophie Skarbek, Sana Sharrack, and @jamesmeiring.bsky.social for all your efforts 🙏
Hi @mattfrieman.bsky.social - TL;DR - our key conceptual advance is that different blood transcriptional biomarkers discriminate early and late phases of infection as a result of cell-specific epigenetic regulation and have important translational applications for respiratory virus infections:
Check out our paper on RNA biomarkers in COVID-19
MX1 expression occurred early in infection before PCR detection…potential role to stratify treatment
#IDSky
The problem is, the length of treatment in the control arm of these trials is far longer than is currently recommended in most guidance. NICE guidance in the UK for CAP is 5 days. PCT is just guiding you to do the same thing that robust guidance/RCT evidence is already telling you. Not a useful test
Poignant frontline perspective of a #Rwandan physician responding to the recent #marburg outbreak. It is well worth a read. We are are two weeks into the 42 day countdown to declaring the outbreak over🤞🏾. These brave HCPs kept us safe. #medsky #idsky 🧪
www.nejm.org/doi/full/10....
Fantastic session at #Medplus in the @rcphysicians.bsky.social today chairing cases from the Imported Fever Service with Sarah Logan. Thanks a bunch to all our panelists and speakers, you were all brilliant. If you’re at Med+ or joining online and missed it, do watch it back!
