The Feinstein Institute for Medical Research, Manhasset, New York, USA
Rheumatology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Ann Rheum Dis. 2020 Jun;79(6):787-792. doi: 10.1136/annrheumdis-2019-216753. Epub 2020 Apr 2.
To evaluate the impact of laboratory results on scoring of the Physician Global Assessment (PGA) of disease activity in systemic lupus erythematosus.
Fifty clinical vignettes were presented via an online survey to a group of international lupus experts. For each case, respondents scored the PGA pre and post knowledge of laboratory test results (pre-lab and post-lab PGAs). Agreement between individual assessors and relationships between pre-lab and post-lab PGAs, and PGAs and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) were determined. Respondents were also asked about factors they incorporate into their PGA determinations.
Sixty surveys were completed. The inter-rater PGA reliability was excellent (pre-lab intraclass correlation coefficient (ICC) 0.98; post-lab ICC 0.99). Post-lab PGAs were higher than pre-lab PGAs: median (IQR) pre-lab PGA 0.5 (1.05), post-lab PGA 1 (1.3) (p<0.001), with a median (IQR) difference of 0.2 (0.45). In general, all abnormal labs including elevated anti-double stranded DNA antibody level (dsDNA) and low complement impacted PGA assessment. Cases with weakest correlations between pre-lab and post-lab PGA were characterised by laboratory results revealing nephritis and/or haematological manifestations. Both pre-lab and post-lab PGAs correlated with SLEDAI-2K. However, a significantly stronger correlation was observed between post-lab PGA and SLEDAI-2K. Multiple factors influenced PGA determinations. Some factors were considered by an overwhelming majority of lupus experts, with less agreement on others.
We found excellent inter-rater reliability for PGAs in a group of international lupus experts. Post-lab PGA scores were higher than pre-lab PGA scores, with a significantly stronger correlation with the SLEDAI-2K. Our findings indicate that PGA scoring should be performed with knowledge of pertinent laboratory results.
评估实验室结果对系统性红斑狼疮患者疾病活动的医师总体评估（PGA）评分的影响。
通过在线调查向一组国际狼疮专家展示了 50 个临床病例。对于每个病例，受访者在了解实验室检测结果（预实验室和后实验室 PGA）前后对 PGA 进行评分。确定了个体评估者之间的一致性以及 PGA 与系统性红斑狼疮疾病活动指数 2000（SLEDAI-2K）之间的关系。还询问了受访者将哪些因素纳入 PGA 确定中。
共完成了 60 项调查。PGA 的组内一致性非常好（预实验室 ICC 为 0.98；后实验室 ICC 为 0.99）。后实验室 PGA 高于预实验室 PGA：中位数（IQR）预实验室 PGA 为 0.5（1.05），后实验室 PGA 为 1（1.3）（p<0.001），中位数（IQR）差值为 0.2（0.45）。一般来说，所有异常实验室检查结果，包括抗双链 DNA 抗体水平升高（dsDNA）和补体降低，都会影响 PGA 评估。预实验室和后实验室 PGA 相关性最差的病例特征是实验室检查结果显示肾炎和/或血液学表现。预实验室和后实验室 PGA 均与 SLEDAI-2K 相关。然而，后实验室 PGA 与 SLEDAI-2K 之间的相关性更强。多个因素影响 PGA 确定。大多数狼疮专家都考虑了一些因素，但对于其他因素的意见并不一致。
我们发现一组国际狼疮专家的 PGA 组内一致性非常好。后实验室 PGA 评分高于预实验室 PGA 评分，与 SLEDAI-2K 的相关性更强。我们的研究结果表明，PGA 评分应在了解相关实验室结果的基础上进行。
