Department of nephrology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
"Diaverum Morarilor" Nephrology and Dialysis Medical Center, 022452 Bucharest, Romania.
Medicina (Kaunas). 2024 Jul 23;60(8):1191. doi: 10.3390/medicina60081191.
Systemic-inflammation-based prognostic scores and hematological indices have shown value in predicting outcomes in various clinical settings. However, their effectiveness in predicting outcomes specifically for IgA nephropathy (IgAN) and membranous nephropathy (MN), the most common primary glomerular diseases diagnosed by kidney biopsy, has not been thoroughly investigated. We conducted a retrospective, observational study involving 334 adult patients with biopsy-proven IgAN (196 patients) and MN (138 patients) from January 2008 to December 2017 at a tertiary center. We assessed six prognostic scores [Glasgow prognostic score (GPS), modified GPS (mGPS), prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-C-reactive protein ratio (LCRP)] and two hematological indices [red blood cell distribution width (RDW), platelet distribution width (PDW)] at diagnosis and examined their relationship with kidney and patient survival. End-stage kidney disease (ESKD) occurred more frequently in the IgAN group compared to the MN group (37% vs. 12%, = 0.001). The mean kidney survival time was 10.7 years in the IgAN cohort and 13.8 years in the MN cohort. After adjusting for eGFR and proteinuria, lower NLR and higher LCRP were significant risk factors for ESKD in IgAN. In the MN cohort, no systemic-inflammation-based scores or hematological indices were associated with kidney survival. There were 38 deaths (19%) in the IgAN group and 29 deaths (21%) in the MN group, showing no significant difference in mortality rates. The mean survival time was 13.4 years for the IgAN group and 12.7 years for the MN group. In the IgAN group, a lower PLR was associated with a higher mortality after adjusting for age, the Charlson comorbidity score, eGFR, and proteinuria. In patients with MN, higher NLR, PLR, and RDW were associated with increased mortality. NLR and LCRP are significant predictors of ESKD in IgAN, while PLR is linked to increased mortality. In MN, NLR, PLR, and RDW are predictors of mortality but not kidney survival. These findings underscore the need for disease-specific biomarkers and indicate that systemic inflammatory responses play varying roles in the progression and outcomes of these glomerular diseases. Future studies on larger cohorts are necessary to validate these markers.
基于全身炎症的预后评分和血液学指标已在各种临床情况下预测结局方面显示出价值。然而，它们在预测特定于免疫球蛋白 A 肾病（IgAN）和膜性肾病（MN）的结局方面的有效性尚未得到彻底研究，这两种疾病是通过肾脏活检诊断的最常见原发性肾小球疾病。我们进行了一项回顾性、观察性研究，纳入了 2008 年 1 月至 2017 年 12 月在一家三级中心接受活检证实的 IgAN（196 例）和 MN（138 例）的 334 例成年患者。我们评估了 6 种预后评分[格拉斯哥预后评分（GPS）、改良 GPS（mGPS）、预后营养指数（PNI）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与 C 反应蛋白比值（LCRP）]和 2 种血液学指标[红细胞分布宽度（RDW）、血小板分布宽度（PDW）]，并在诊断时检查了它们与肾脏和患者生存的关系。IgAN 组的终末期肾病（ESKD）发生率高于 MN 组（37% vs. 12%，=0.001）。IgAN 队列的平均肾脏生存时间为 10.7 年，MN 队列为 13.8 年。在调整 eGFR 和蛋白尿后，较低的 NLR 和较高的 LCRP 是 IgAN 发生 ESKD 的显著危险因素。在 MN 队列中，没有基于全身炎症的评分或血液学指标与肾脏生存相关。IgAN 组有 38 例（19%）死亡，MN 组有 29 例（21%）死亡，死亡率无显著差异。IgAN 组的平均生存时间为 13.4 年，MN 组为 12.7 年。在 IgAN 组中，在调整年龄、Charlson 合并症评分、eGFR 和蛋白尿后，较低的 PLR 与较高的死亡率相关。在 MN 患者中，较高的 NLR、PLR 和 RDW 与死亡率增加相关。NLR 和 LCRP 是 IgAN 发生 ESKD 的重要预测因素，而 PLR 与死亡率增加相关。在 MN 中，NLR、PLR 和 RDW 是死亡率的预测因素，但不是肾脏生存的预测因素。这些发现强调了需要针对特定疾病的生物标志物，并表明全身炎症反应在这些肾小球疾病的进展和结局中发挥着不同的作用。需要进一步在更大的队列中进行研究来验证这些标志物。
