Department of Clinical Epidemiology, The First Hospital of Jilin University, Changchun, China.
Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China.
Lupus Sci Med. 2022 May;9(1). doi: 10.1136/lupus-2022-000677.
Based on clinical and laboratory indicators, this study aimed to establish a multiparametric nomogram to assess the risk of refractory cases of SLE-related thrombocytopenia (SLE-related TP) before systematic treatment.
From June 2012 to July 2021, a dual-centre retrospective cohort study of prospectively collected data of patients with SLE-related TP was conducted. The cohort data were divided into a developing set, internal validation set and external validation set. Refractory thrombocytopenia (RTP) was defined as failed to prednisone at 1 mg/kg per day with a platelet count cannot achieve or maintain higher than 50×10/L. In the developing set, a nomogram were established to predict RTP risk based on clinical characteristics and laboratory indicators by multivariable logistic regression, and its performance was assessed by receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA) and clinical impact curve (CIC).
A total of 1778 patients with SLE were included, and 413 eligible patients were involved in the final analysis with 121 RTPs. The RTP risk assessment (RRA) model was composed of five significant risk variables: pregnancy, severity of TP, complement 3, anticardiolipin antibody-immunoglobulin G and autoimmune haemolytic anaemia. In three datasets, the AUCs were 0.887 (95% CI 0.830 to 0.945), 0.880 (95% CI 0.785 to 0.975) and 0.871 (95% CI 0.793 to 0.949), respectively. The calibration curve, DCA and CIC all showed good performance of the RRA model.
The RRA model demonstrated good capability for assessing the refractory risk in SLE-related TP, which may be helpful for early identification and intervention.
基于临床和实验室指标，本研究旨在建立一个多参数列线图，以评估系统性治疗前系统性红斑狼疮相关血小板减少症（SLE 相关 TP）难治病例的风险。
本研究为前瞻性收集 SLE 相关 TP 患者数据的双中心回顾性队列研究。队列数据分为开发集、内部验证集和外部验证集。难治性血小板减少症（RTP）定义为泼尼松 1mg/kg 天治疗失败，血小板计数不能达到或维持在 50×10/L 以上。在开发集中，采用多变量逻辑回归基于临床特征和实验室指标建立预测 RTP 风险的列线图，并通过接受者操作特征（ROC）曲线、校准曲线、决策曲线分析（DCA）和临床影响曲线（CIC）评估其性能。
共纳入 1778 例 SLE 患者，最终分析纳入 413 例符合条件的患者，其中 121 例为 RTP。RTP 风险评估（RRA）模型由 5 个显著风险变量组成：妊娠、TP 严重程度、补体 3、抗心磷脂抗体 IgG 和自身免疫性溶血性贫血。在三个数据集，AUC 分别为 0.887（95%CI 0.830 至 0.945）、0.880（95%CI 0.785 至 0.975）和 0.871（95%CI 0.793 至 0.949）。校准曲线、DCA 和 CIC 均显示 RRA 模型具有良好的性能。
RRA 模型对评估 SLE 相关 TP 的难治风险具有良好的能力，可能有助于早期识别和干预。
