Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
Clin Exp Nephrol. 2024 Jan;28(1):59-66. doi: 10.1007/s10157-023-02402-5. Epub 2023 Sep 15.
This study aimed to externally validate the pediatric International IgA Nephropathy (IgAN) Prediction Tool updated from the adult IgAN Prediction Tool.
439 children with biopsy-confirmed idiopathic IgAN were enrolled in this external validation study. The primary outcome was a 30% decline in eGFR or end-stage kidney disease. We evaluated the discrimination using Harrell's C-index, the receiver operating characteristic (ROC) curve, and Kaplan-Meier curves for four risk groups (< 16th [low risk], ∼16 to < 50th [intermediate risk], ∼50 to < 84th [high risk], and ≥ 84th percentiles [highest risk] of linear predictor). Calibration was assessed using calibration plots.
The median follow-up time of the 439 patients was 4.5 (2.7-6.8) years, and 27 patients reached the primary outcome. Compared with the reported cohorts, our cohort was more contemporary, with milder proteinuria at biopsy, and had lower proportions of S1 and T1 lesions. Harrell's C-index and area under the ROC curve at 5 years were < 0.7 for both the models with and without race. The Kaplan-Meier curves of the risk groups were not well separated for the two models, only separated completely between the highest-risk group and the others for the model without race. The two models generally overestimated the risk of the primary outcome, CONCLUSION: The model without race could accurately distinguish the highest-risk patients from patients with low, intermediate, and high risk for kidney progression. Discrimination and calibration for the full model with or without race were unsatisfactory in this contemporary cohort in central China.
本研究旨在对从成人 IgAN 预测工具更新而来的儿科国际 IgA 肾病（IgAN）预测工具进行外部验证。
本外部验证研究纳入了 439 名经活检证实的特发性 IgAN 患儿。主要结局是 eGFR 下降 30%或终末期肾病。我们使用 Harrell's C 指数、受试者工作特征（ROC）曲线和 Kaplan-Meier 曲线评估了四个风险组（<第 16 百分位[低风险]、第 16 至<第 50 百分位[中危]、第 50 至<第 84 百分位[高危]和≥第 84 百分位[高危]）的鉴别能力线性预测器）。通过校准图评估校准。
439 例患者的中位随访时间为 4.5（2.7-6.8）年，27 例患者达到主要结局。与报告的队列相比，我们的队列更具现代性，活检时蛋白尿较轻，S1 和 T1 病变的比例较低。两个模型的 Harrell's C 指数和 ROC 曲线下面积在 5 年内均<0.7，包括有无种族。两个模型的风险组的 Kaplan-Meier 曲线未很好地区分开，而无种族模型仅在最高风险组和其他组之间完全分开。两个模型通常高估了主要结局的风险。
无种族模型可准确区分高危患者与低、中、高危患者的肾脏进展。在该研究中，种族因素对模型的判别能力和校准能力没有影响。在中国中部的当代队列中，全模型（包括或不包括种族）的判别能力和校准能力均不理想。
