Enhancing mortality prediction in AIDS and disseminated Talaromyces marneffei: the impact of novel inflammatory markers in a nomogram

<b>Introduction.</b> <i>Talaromyces marneffei</i> (TM) is a common opportunistic infection among patients with AIDS, characterized by rapid systemic dissemination and a high mortality rate. Early identification of patients at risk of death is critical to improving clinical outcomes.<b>Hypothesis/Gap Statement.</b> Despite the severity of disseminated TM infection (DPSM), few predictive tools exist to assess mortality risk in affected AIDS patients. A clinical prediction model incorporating novel inflammatory markers may help guide timely intervention.<b>Aim.</b> This study aimed to identify independent risk factors for mortality in AIDS patients with DPSM and to develop and validate a nomogram for individualized risk prediction.<b>Methodology.</b> A retrospective study was conducted on 174 AIDS patients with DPSM and complete clinical data admitted to Hangzhou Xixi Hospital between January 2013 and June 2024. A training cohort of 104 patients was used to identify mortality-related risk factors via logistic regression and to construct a predictive nomogram. The remaining 70 patients constituted a validation cohort to evaluate the model using area under the curve (AUC), decision curve analysis (DCA) and calibration curves.<b>Results.</b> The overall mortality rate was 18.97% (33/174). Effusion, bone marrow suppression, systemic inflammation and malnutrition were significantly associated with fatal outcomes (<i>P</i><0.05). Multivariate logistic regression identified white blood cell count, C-reactive protein-to-prealbumin ratio and procalcitonin-to-albumin ratio as independent risk factors for mortality. The nomogram based on these predictors showed strong discriminative power in both training and validation cohorts (AUC=0.89 and 0.78, respectively). DCA demonstrated the clinical utility and net benefit of the model.<b>Conclusion.</b> This study identified key predictors of mortality in AIDS patients with DPSM and developed a validated nomogram incorporating novel inflammatory markers. The tool offers potential value for individualized risk assessment and clinical decision-making.