A. Ni, MD, L. Chen, MD, L. Lan, MD, Y. Wang, MD, P. Ren, MD, Y. Zhu, MD, Y. Xu, MD, X. Shen, MD, Q. Zhou, MD, X. Huang, MD, H. Wang, MD, J. Chen, MD, F. Han, MD, Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, and Institute of Nephrology, Zhejiang University, and Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, and Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, Zhejiang, China.
J Rheumatol. 2023 May;50(5):662-670. doi: 10.3899/jrheum.220818. Epub 2023 Jan 15.
We aimed to validate and modify the renal risk score for antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN) in a Chinese cohort with a majority of myeloperoxidase (MPO)-positive patients.
A total of 285 patients with biopsy-proven AAGN in our center were retrospectively included. Patients were randomly assigned to the development set (n = 201) and the validation set (n = 84). We calculated the renal risk score and analyzed the clinicopathological characteristics and follow-up data. The nomogram was constructed based on the independent prognostic factors identified by the multivariable Cox regression and then compared with the renal risk score.
Over a median follow-up period of 41.3 (range 20.0-63.8) months, 84 (29.5%) patients reached end-stage kidney disease (ESKD). In the development set, hypertension (hazard ratio [HR] 2.16, 95% CI 1.08-4.32, = 0.03), high serum creatinine (HR 1.002, 95% CI 1.001-1.003, < 0.001), high daily urine protein (HR 1.34, 95% CI 1.15-1.57, < 0.001), high glomerular sclerosis (HR 13.98, 95% CI 3.50-55.92, < 0.001), and interstitial fibrosis > 50% (HR 4.18, 95% CI 1.90-9.19, < 0.001) were independent risk factors for ESKD, and these indicators were included in the nomogram. The C-indices of the nomogram model in the development set, validation set, and all-data set were 0.838 (range 0.785-0.891), 0.794 (range 0.774-0.814), and 0.822 (range 0.775-0.869), respectively, which were higher than those of the renal risk score model, 0.801 (range 0.748-0.854), 0.746 (range 0.654-0.838) and 0.783 (range 0.736-0.830), respectively. The net reclassification improvement and the integrated discrimination improvement further illustrated the higher predictive ability of the nomogram.
We present a nomogram as a practical tool to predict renal outcomes in Chinese patients with MPO-ANCA glomerulonephritis.
我们旨在验证和修正中国人群抗中性粒细胞胞浆抗体（ANCA）相关性肾小球肾炎（AAGN）中肾风险评分，该人群以髓过氧化物酶（MPO）阳性患者为主。
回顾性纳入我院 285 例经肾活检证实的 AAGN 患者。患者被随机分配到发展数据集（n = 201）和验证数据集（n = 84）。我们计算了肾风险评分，并分析了临床病理特征和随访数据。基于多变量 Cox 回归确定的独立预后因素构建了列线图，并与肾风险评分进行了比较。
在中位随访期 41.3（范围 20.0-63.8）个月内，84 例（29.5%）患者达到终末期肾病（ESKD）。在发展数据集，高血压（危险比 [HR] 2.16，95%置信区间 [CI] 1.08-4.32， = 0.03）、高血清肌酐（HR 1.002，95%CI 1.001-1.003， < 0.001）、高每日尿蛋白（HR 1.34，95%CI 1.15-1.57， < 0.001）、肾小球硬化率高（HR 13.98，95%CI 3.50-55.92， < 0.001）和间质纤维化> 50%（HR 4.18，95%CI 1.90-9.19， < 0.001）是 ESKD 的独立危险因素，这些指标被纳入了列线图。在发展数据集、验证数据集和全部数据集，列线图模型的 C 指数分别为 0.838（范围 0.785-0.891）、0.794（范围 0.774-0.814）和 0.822（范围 0.775-0.869），高于肾风险评分模型的 0.801（范围 0.748-0.854）、0.746（范围 0.654-0.838）和 0.783（范围 0.736-0.830）。净重新分类改善和综合判别改善进一步说明了列线图具有更高的预测能力。
我们提出了一个列线图作为预测中国 MPO-ANCA 肾小球肾炎患者肾结局的实用工具。
