老年抗中性粒细胞胞浆抗体相关性血管炎患者的肾脏结局：一个新的预测模型。

Renal Outcomes in Older Adults with Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis: A New Prediction Model.

机构信息

State Key Laboratory of Complex Severe and Rare Diseases, Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.

出版信息

Am J Nephrol. 2023;54(9-10):399-407. doi: 10.1159/000533512. Epub 2023 Sep 14.

DOI:10.1159/000533512

PMID:37708862

Abstract

INTRODUCTION

Older patients with antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) commonly experience renal impairment and poor prognoses. This study aimed to establish a risk-scoring system for predicting composite renal outcomes in older patients with AAV.

METHODS

This retrospective observational study included all patients with AAV hospitalized in a single-center tertiary hospital in China between January 2013 and April 2022. Patients aged ≥65 years were defined as older adults and short-term composite renal outcomes included a ≥25% reduction in estimated glomerular filtration rate (eGFR) (for AKI), renal replacement therapy, provision of renal replacement therapy (long-term dialysis, kidney transplant, or sustained eGFR <15 mL/min/1.73 m), or all-cause mortality. Patients were randomly divided into development and validation cohorts (2:1). Logistic regression analysis was performed in the development cohort to analyze risk factors. The scoring system was established accordingly and further validated in the validation cohort.

RESULTS

1,203 patients were enrolled in the study, among whom the older adult group accounted for 36% with a mean age of 71. The older adult group had a worse prognosis, a higher mortality rate, a higher rate of end-stage renal disease, and worsening renal function. Logistic regression showed that age >75 years, chronic heart disease, and elevated serum creatinine and D-dimer values were risk factors for poor prognosis in patients with AAV. The development and validation cohorts in patients with AAV produced area under the curve values of 0.82 (0.78-0.86) and 0.83 (0.77-0.89), respectively.

CONCLUSION

We established a risk-scoring system based on baseline clinical characteristics to predict composite renal outcomes in patients with AAV. Our results suggest that more attention should be paid to older patients with severe renal impairment and active inflammation.

摘要

简介

患有抗中性粒细胞胞浆抗体相关性血管炎（AAV）的老年患者常伴有肾功能损害和预后不良。本研究旨在建立预测老年 AAV 患者复合肾脏结局的风险评分系统。

方法

本回顾性观察性研究纳入了 2013 年 1 月至 2022 年 4 月期间在中国一家单中心三级医院住院的所有 AAV 患者。年龄≥65 岁的患者被定义为老年患者，短期复合肾脏结局包括估算肾小球滤过率（eGFR）下降≥25%（急性肾损伤[AKI]）、需要肾脏替代治疗、提供肾脏替代治疗（长期透析、肾移植或持续 eGFR＜15 mL/min/1.73 m 2 ）或全因死亡率。患者被随机分为开发和验证队列（2:1）。在开发队列中进行逻辑回归分析以分析危险因素。根据该分析结果建立评分系统，并在验证队列中进一步验证。

结果

本研究共纳入 1203 例患者，其中老年组占 36%，平均年龄为 71 岁。老年组预后较差，死亡率较高，终末期肾病发生率较高，肾功能恶化。逻辑回归显示，年龄＞75 岁、慢性心脏病以及血清肌酐和 D-二聚体升高是 AAV 患者预后不良的危险因素。AAV 患者的开发和验证队列的曲线下面积分别为 0.82（0.78-0.86）和 0.83（0.77-0.89）。