Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
RMD Open. 2023 Nov 23;9(4):e003568. doi: 10.1136/rmdopen-2023-003568.
Patients with systemic lupus erythematosus (SLE) have an increased risk of venous thromboembolism (VTE). We conducted this study to develop a risk score algorithm for VTE in patients with SLE that provides individualised risk estimates.
We developed a clinical prediction model of VTE in 4502 patients with SLE based on the Chinese SLE Treatment and Research group cohort (CSTAR) from January 2009 to January 2020 and externally validated in 3780 patients with SLE in CSTAR from January 2020 to January 2022. Baseline data were obtained and VTE events were recorded during the follow-up. The prediction model was developed to predict VTE risk within 6 months in patients with SLE, using multivariate logistic regression and least absolute shrinkage and selection operator. SLE-VTE score and nomogram were established according to the model.
A total of 4502 patients included in the development cohort, 135 had VTE events. The final prediction model (SLE-VTE score) included 11 variables: gender, age, body mass index, hyperlipidaemia, hypoalbuminaemia, C reactive protein, anti-β2GPI antibodies, lupus anticoagulant, renal involvement, nervous system involvement and hydroxychloroquine, with area under the curve of 0.947 and 0.808 in the development (n=4502) and external validation cohort (n=3780), respectively. According to the net benefit and predicted probability thresholds, we recommend annual screening of VTE in high risk (≥1.03%) patients with SLE.
Various factors are related to the occurrence of VTE in patients with SLE. The proposed SLE-VTE risk score can accurately predict the risk of VTE and help identify patients with SLE with a high risk of VTE who may benefit from thromboprophylaxis.
系统性红斑狼疮（SLE）患者发生静脉血栓栓塞症（VTE）的风险增加。我们开展此项研究，旨在建立 SLE 患者 VTE 风险评分算法，为患者提供个体化风险评估。
我们基于中国系统性红斑狼疮研究协作组（CSTAR）队列（2009 年 1 月至 2020 年 1 月）中的 4502 例 SLE 患者数据建立了 VTE 临床预测模型，并于 2020 年 1 月至 2022 年 1 月在 CSTAR 队列中的 3780 例 SLE 患者中进行了外部验证。收集患者基线数据并随访 VTE 事件。使用多变量逻辑回归和最小绝对收缩和选择算子（least absolute shrinkage and selection operator，LASSO）建立预测模型，以预测 SLE 患者 6 个月内 VTE 风险。根据该模型建立了 SLE-VTE 评分和列线图。
纳入开发队列的 4502 例患者中，共有 135 例发生 VTE 事件。最终预测模型（SLE-VTE 评分）包含 11 个变量：性别、年龄、体质指数、高脂血症、低白蛋白血症、C 反应蛋白、抗β2糖蛋白 I 抗体、狼疮抗凝物、肾脏受累、神经系统受累和羟氯喹，在开发队列（n=4502）和外部验证队列（n=3780）中曲线下面积分别为 0.947 和 0.808。根据净获益和预测概率阈值，我们建议对高危（≥1.03%）SLE 患者进行年度 VTE 筛查。
多种因素与 SLE 患者 VTE 的发生有关。所提出的 SLE-VTE 风险评分可以准确预测 VTE 风险，有助于识别 SLE 患者中 VTE 风险较高的患者，这些患者可能受益于血栓预防。
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