Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China.
West China School of Medicine, Sichuan University, Chengdu, China.
Front Immunol. 2022 May 19;13:842362. doi: 10.3389/fimmu.2022.842362. eCollection 2022.
Chronic inflammation is related to the development of IgA nephropathy (IgAN). Emerging studies have reported that platelet-related parameters including platelet (PLT), platelet-to-albumin ratio (PAR), and platelet-to-lymphocyte ratio (PLR) are proved to be novel prognostic indicators for several inflammatory diseases. Whether platelet-related parameters could serve as predictors for IgAN remains unknown.
A total of 966 IgAN patients were enrolled in this retrospective study and were divided into several groups based on the optimal cut-off value of the platelet-related parameters. End-stage renal disease was used as the renal endpoint. A 1:2 propensity score (PS) match was then carried out to eliminate significant differences at baseline. The area under the receiver operating characteristic curve (AUROC), Kaplan-Meier (K-M) curve, and Cox proportional hazards analyses were performed to evaluate their predictive effect.
Without considering the effect of covariates, the K-M curve showed that PLT, PLR, and PAR were strongly correlated with the renal outcomes of IgAN. However, the AUROC revealed that the PAR and PLR had better predictive power than the PLT. Multivariate Cox regression adjusting for demographic data, pathological findings, treatment, and laboratory results indicated that compared with PLR, albumin and PLT, PAR seemed to be a better marker of adverse renal outcome, implying that PAR was the only platelet-related parameter that could be used as an independent risk factor. Notably, high PAR patients seemed to have more severe clinical manifestations and pathological lesions. However, after eliminating the influence of different baselines on outcome variables, the PAR could still predict the poor prognosis of IgAN. To more accurately evaluate the predictive power of the PAR, we analyzed the predictive effect of the PAR on patients with different clinicopathological characteristics through subgroup analysis. It was indicated that the PAR might better predict the prognosis and outcome of patients whose disease was already very severe.
PAR might be used as an independent risk factor for IgAN progression.
慢性炎症与 IgA 肾病（IgAN）的发展有关。新兴研究报告称，血小板相关参数，包括血小板（PLT）、血小板与白蛋白比值（PAR）和血小板与淋巴细胞比值（PLR），已被证明是几种炎症性疾病的新型预后指标。血小板相关参数是否可作为 IgAN 的预测指标尚不清楚。
本回顾性研究共纳入 966 例 IgAN 患者，并根据血小板相关参数的最佳截断值将其分为几组。终末期肾病（ESRD）被用作肾脏终点。然后进行 1:2 倾向评分（PS）匹配，以消除基线时的显著差异。采用受试者工作特征曲线（ROC）下面积（AUROC）、Kaplan-Meier（K-M）曲线和 Cox 比例风险分析来评估其预测效果。
在不考虑协变量影响的情况下，K-M 曲线表明 PLT、PLR 和 PAR 与 IgAN 的肾脏结局密切相关。然而，AUROC 显示 PAR 和 PLR 比 PLT 具有更好的预测能力。多变量 Cox 回归分析调整了人口统计学数据、病理发现、治疗和实验室结果，表明与 PLR、白蛋白和 PLT 相比，PAR 似乎是不良肾脏结局的更好标志物，这表明 PAR 是唯一可作为独立危险因素的血小板相关参数。值得注意的是，高 PAR 患者似乎具有更严重的临床表现和病理损伤。然而，在消除不同基线对结局变量的影响后，PAR 仍然可以预测 IgAN 的不良预后。为了更准确地评估 PAR 的预测能力，我们通过亚组分析分析了 PAR 对不同临床病理特征患者的预测效果。结果表明，PAR 可能更好地预测疾病已经非常严重的患者的预后和结局。
PAR 可能作为 IgAN 进展的独立危险因素。
