Restrepo-Escobar Mauricio, Granda-Carvajal Paula Andrea, Jaimes Fabián
Department of Internal Medicine Rheumatology Research Group-GRUA - (in Spanish Grupo de Reumatología de la Universidad de Antioquia) - School of Medicine at Universidad de Antioquia, Hospital Universitario de San Vicente Fundación, Medellín, Colombia; Hospital Pablo Tobón Uribe, Medellin, Colombia.
Hospital Pablo Tobón Uribe, Medellin, Colombia.
Reumatol Clin (Engl Ed). 2019 Jan-Feb;15(1):27-33. doi: 10.1016/j.reuma.2017.05.010. Epub 2017 Jul 18.
To develop a multivariable clinical prediction model for the requirement of aggressive immunosuppression with cytostatics, based on simple clinical record data and lab tests. The model is defined in accordance with the result of the kidney biopsies.
Retrospective study conducted with data from patients 16 years and older, with SLE and nephritis with less than 6 months of evolution. An initial bivariate analysis was conducted to select the variables to be included in a multiple logistic regression model. Goodness of fit was evaluated using a Hosmer-Lemeshow test (H-L) and the discrimination capacity of the model by means of the area under the ROC (AUC) curve.
Data from 242 patients was gathered; of these, 18.2% (n=44) did not need an addition of cytostatics according to the findings of their kidney biopsies. The variables included in the final model were 24-h proteinuria, diastolic blood pressure, creatinine, C3 complement and the interaction of hematuria with leukocyturia in urinary sediment. The model showed excellent discrimination (AUC=0.929; 95% CI=0.894-0.963) and adequate calibration (H-L, P=.959).
In recent-onset LN patients, the decision to use or not to use intensive immunosuppressive therapy could be performed based on our prediction model as an alternative to kidney biopsies.
基于简单的临床记录数据和实验室检查，开发一种用于预测细胞毒性药物强化免疫抑制需求的多变量临床预测模型。该模型根据肾活检结果定义。
对16岁及以上患有系统性红斑狼疮（SLE）且病程小于6个月的肾炎患者的数据进行回顾性研究。进行初始双变量分析以选择纳入多元逻辑回归模型的变量。使用Hosmer-Lemeshow检验（H-L）评估拟合优度，并通过ROC曲线下面积（AUC）评估模型的辨别能力。
收集了242例患者的数据；其中，根据肾活检结果，18.2%（n = 44）的患者不需要加用细胞毒性药物。最终模型纳入的变量为24小时蛋白尿、舒张压、肌酐、C3补体以及尿沉渣中血尿与白细胞尿的相互作用。该模型显示出优异的辨别能力（AUC = 0.929；95%CI = 0.894 - 0.963）和良好的校准度（H-L，P = 0.959）。
在新发病的狼疮性肾炎（LN）患者中，可根据我们的预测模型决定是否使用强化免疫抑制治疗，作为肾活检的替代方法。
