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Objective: The systemic immune-inflammation index (SII) represents a promising yet underexplored biomarker in HIV-associated cryptococcal meningitis (HCM). The study aimed to assess the association between SII levels before and during treatment, and 24-week outcomes in HCM patients, as well as its potential for predicting mortality. Methods: This was a secondary analysis of a prospective multicenter study involving HIV patients with newly diagnosed cryptococcal meningitis (CM). SII was measured at baseline, and at weeks 2 and 4 following initiation of induction antifungal therapy. Correlations between baseline SII levels and clinicopathological factors were analyzed. We also investigated the relationship that baseline and on-treatment SII levels may have on patient cumulative mortality. Results: In total, 21.8% (54/248) of HCM patients succumbed within the 24-week follow-up period. Baseline SII levels were significantly higher in HCM patients compared to those with HIV without CM ( p < 0.0001). In patients with HCM, SII levels during treatment were significantly higher in non-survivors than in survivors. Furthermore, a negative correlation was observed between SII levels and CD4+ T-cell counts in HCM patients (r=− 0.245, p < 0.001). After adjusting for potential confounders, elevated SII levels at weeks 2 and 4 remained independently associated with a 2.5-fold and 5.5-fold increased risk of mortality, respectively adjusted hazard ratio (95% CI): 2.51 (1.09— 5.76), p =0.03; 5.47 (2.38— 12.6), p < 0.001, respectively. Moreover, the combination of SII levels at weeks 2 and 4, as well as their integration with impaired consciousness (IC) status, effectively predicted poor outcomes within 24 weeks. Conclusion: Elevated SII levels during treatment are independently associated with increased 24-week mortality in HCM patients, suggesting the potential of SII as an effective prognostic biomarker. The integration of the SII into IC indicators for risk stratification further improves prognostic accuracy. Keywords: HIV, cryptococcal meningitis, systemic immune-inflammation index, biomarkers, prognostic analysis
Zhao et al. (Mon,) studied this question.