一种用于系统性红斑狼疮神经精神事件归因的新算法的开发与验证
Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus.
作者信息
Bortoluzzi Alessandra, Scirè Carlo Alberto, Bombardieri Stefano, Caniatti Luisa, Conti Fabrizio, De Vita Salvatore, Doria Andrea, Ferraccioli Gianfranco, Gremese Elisa, Mansutti Elisa, Mathieu Alessandro, Mosca Marta, Padovan Melissa, Piga Matteo, Tincani Angela, Tola Maria Rosaria, Tomietto Paola, Valesini Guido, Zen Margherita, Govoni Marcello
机构信息
Department of Medical Science, Section of Hematology and Rheumatology, University of Ferrara and Azienda Ospedaliero Universitaria Sant'Anna di Cona, Ferrara, Epidemiology Unit, Italian Society of Rheumatology, Milan, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Department of Neuroscience, S. Anna Hospital, Cona, Ferrara, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Rheumatology Clinic, Azienda Ospedaliero Universitaria 'S. Maria della Misericordia' and DSMB, Department of Medical and Biological Sciences, University of Udine, Udine, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Padova, Padova, Division of Rheumatology and Internal Medicine, Institute of Rheumatology and Affine Sciences, CIC, Catholic University of the Sacred Heart, Rome, Rheumatology Unit, Department of Medical Sciences, University of Cagliari and AOU University Clinic, Cagliari, Rheumatology and Clinical Immunology Unit, Spedali Civili and University of Brescia, Brescia and Internal Medicine, AOU 'Ospedali Riuniti' of Trieste, Trieste, Italy
Department of Medical Science, Section of Hematology and Rheumatology, University of Ferrara and Azienda Ospedaliero Universitaria Sant'Anna di Cona, Ferrara, Epidemiology Unit, Italian Society of Rheumatology, Milan, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Department of Neuroscience, S. Anna Hospital, Cona, Ferrara, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Rheumatology Clinic, Azienda Ospedaliero Universitaria 'S. Maria della Misericordia' and DSMB, Department of Medical and Biological Sciences, University of Udine, Udine, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Padova, Padova, Division of Rheumatology and Internal Medicine, Institute of Rheumatology and Affine Sciences, CIC, Catholic University of the Sacred Heart, Rome, Rheumatology Unit, Department of Medical Sciences, University of Cagliari and AOU University Clinic, Cagliari, Rheumatology and Clinical Immunology Unit, Spedali Civili and University of Brescia, Brescia and Internal Medicine, AOU 'Ospedali Riuniti' of Trieste, Trieste, Italy.
出版信息
Rheumatology (Oxford). 2015 May;54(5):891-8. doi: 10.1093/rheumatology/keu384. Epub 2014 Oct 21.
OBJECTIVE
The aim of this study was to develop and validate an algorithm to assist the attribution of neuropsychiatric (NP) events to underlying disease in SLE patients.
METHODS
Phase 1 identified and categorized candidate items to be included in the algorithm for the attribution of an NP event to SLE and their relative weights through a literature-informed consensus-driven process. Using a retrospective training cohort of SLE, phase 2 validated items selected in phase 1 and refined weights through a data-driven process, fitting items as independent variables and expert evaluation (clinical judgement) as reference standard in logistic models. Phase 3 consisted of a validation process using an external multicentre retrospective SLE cohort.
RESULTS
Phase 1 identified four different items: timing of the NP event, type of event, confounding factors and favouring factors. The training and validating cohorts included 228 and 221 patients, respectively. Each patient experienced at least one NP event characterized using the ACR case definition. In these samples, items selected in phase 1 showed good performance in discriminating patients with NPSLE: the area under the receiver operating characteristic curve using dichotomous outcomes was 0.87 in the training set and 0.82 in the validating set. Relevant cut-offs of the validated score identify events with a positive predictive value of 100% (95% CI 93.2, 100) and 86.3% (95% CI 76.2, 93.2) in the training and validating cohorts, respectively.
CONCLUSION
A new algorithm based on a probability score was developed and validated to determine the relationship between NP events and SLE.
目的
本研究的目的是开发并验证一种算法，以协助将神经精神（NP）事件归因于系统性红斑狼疮（SLE）患者的潜在疾病。
方法
第1阶段通过文献告知的共识驱动过程，识别并分类算法中用于将NP事件归因于SLE的候选项目及其相对权重。使用SLE的回顾性训练队列，第2阶段验证第1阶段选择的项目，并通过数据驱动过程优化权重，将项目作为自变量，专家评估（临床判断）作为逻辑模型中的参考标准。第3阶段包括使用外部多中心回顾性SLE队列进行验证过程。
结果
第1阶段识别出四个不同项目：NP事件的时间、事件类型、混杂因素和支持因素。训练队列和验证队列分别包括228例和221例患者。每位患者至少经历一次符合美国风湿病学会（ACR）病例定义的NP事件。在这些样本中，第1阶段选择的项目在区分神经精神性SLE（NPSLE）患者方面表现良好：使用二分结果时，训练集的受试者工作特征曲线下面积为0.87，验证集为0.82。验证分数的相关临界值分别在训练队列和验证队列中识别出阳性预测值为100%（95%CI 93.2，100）和86.3%（95%CI 76.2，93.2）的事件。
结论
开发并验证了一种基于概率评分的新算法，以确定NP事件与SLE之间的关系。
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