评估 QRISK3 在预测系统性红斑狼疮中心血管事件的有效性。
Assessing the validity of QRISK3 in predicting cardiovascular events in systemic lupus erythematosus.
机构信息
Medicine - Rheumatology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Medicine, University of California Los Angeles, Los Angeles, California, USA.
出版信息
Lupus Sci Med. 2022 Feb;9(1). doi: 10.1136/lupus-2021-000564.
OBJECTIVES
Traditional cardiovascular risk calculators such as the Framingham Risk Score (FRS) have been shown to underestimate risk in patients with SLE. The QRISK3 calculator is unique in including SLE and corticosteroid use as risk factors. This study aims to assess the validity of QRISK3 compared with other cardiovascular risk models in a cohort of patients with SLE in the USA.
METHODS
We studied a prospective cohort of 366 adult patients with SLE without history of any cardiovascular event and followed them for 10 years. We compared the diagnostic performance of QRISK3 with FRS, modified FRS, Atherosclerotic Cardiovascular Disease (ASCVD), and Predictors of Risk for Elevated Flares, Damage Progression and Increased Cardiovascular Disease in Patients with SLE (PREDICTS).
RESULTS
Sixty-four of the 366 patients (17.4%) experienced at least one cardiovascular event during the 10-year follow-up period. Of these patients 45% had a QRISK3 score >10%, whereas 20.5% of patients who did not have an event had a QRISK3 score >10% (p<0.001). The corresponding numbers for FRS, modified FRS, ASCVD and PREDICTS were 11.0% vs 7.2% (p=ns), 40.6% vs 28.0% (p=0.05), 12.2% vs 5.9% (p=ns), and 77% vs 32.1% (p<0.001), respectively. The areas under the receiver operating characteristic curve using QRISK3 >10% and high-risk PREDICTS were both larger than those using ASCVD >10%, FRS >10% and modified FRS >10%.
CONCLUSIONS
Both QRISK3 and PREDICTS demonstrated better performance in predicting risk of cardiovascular disease in this cohort of patients with SLE compared with FRS, modified FRS and ASCVD.
目的
Framingham 风险评分（FRS）等传统心血管风险计算器已被证明低估了 SLE 患者的风险。QRISK3 计算器的独特之处在于将 SLE 和皮质类固醇的使用作为风险因素。本研究旨在评估 QRISK3 在没有任何心血管事件史的美国 SLE 患者队列中的有效性，与其他心血管风险模型进行比较。
方法
我们研究了 366 例无任何心血管事件史的成年 SLE 患者的前瞻性队列，对他们进行了 10 年的随访。我们比较了 QRISK3 与 FRS、改良 FRS、动脉粥样硬化性心血管疾病（ASCVD）和预测风险升高的风险、损伤进展和 SLE 患者心血管疾病增加（PREDICTS）的诊断性能。
结果
在 10 年的随访期间，366 例患者中有 64 例（17.4%）至少发生了一次心血管事件。这些患者中有 45%的 QRISK3 评分>10%，而没有发生事件的患者中有 20.5%的 QRISK3 评分>10%（p<0.001）。FRS、改良 FRS、ASCVD 和 PREDICTS 的相应数字分别为 11.0%与 7.2%（p=ns）、40.6%与 28.0%（p=0.05）、12.2%与 5.9%（p=ns）和 77%与 32.1%（p<0.001）。使用 QRISK3>10%和高危 PREDICTS 的接收器操作特征曲线下面积均大于使用 ASCVD>10%、FRS>10%和改良 FRS>10%。
结论
与 FRS、改良 FRS 和 ASCVD 相比，QRISK3 和 PREDICTS 均能更好地预测 SLE 患者心血管疾病的风险。
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