Guo Qifang, Shao Yijia, Yu Le, Zhang Xiuling, Shang Jingjing, Feng Xueqin, Zhou Wei, Duan Xinwang
Department of Rheumatology and Immunology, Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Clin Respir J. 2025 Apr;19(4):e70067. doi: 10.1111/crj.70067.
Risk assessment and prognosis prediction are crucial for patients with pulmonary involvement in antineutrophil cytoplasimc antibody associated vasculitis (AAV). This study was conducted to create and internally validate a prognostic model for mortality of pulmonary involvement in patients with AAV that provides individualized risk assessments.
A cohort of 150 patients diagnosed with AAV at the Second Affiliated Hospital of Nanchang University Hospital between January 2013 and July 2022 was included, using data obtained from the Chinese Rheumatism Data Center (CRDC). The model was developed using Cox proportional hazards regression and the least absolute shrinkage and selection operator. To validate the model, assessments were conducted for discrimination, calibration, and through decision curve analysis.
The mean survival time of lung involvement AAV patients was 57.0 ± 4.1 months. In the final predictive model for death, four clinical variables were included: age at baseline, history of tumors, baseline hemoglobin level, and the level of the percentage of forced vital capacity to the normal predicted value. One-, two-, and three-year AAV patients with pulmonary involvement mortality probability-predictive nomogram were established. Internal validation of the model was conducted, yielding Harrell's concordance index (0.884), a Brier score of 0.088, and a calibration curve indicating satisfactory performance.
We constructed a risk model utilizing easily accessible clinical risk factors, which could accurately forecast the future mortality risk associated with pulmonary involvement in AAV patients.
风险评估和预后预测对于抗中性粒细胞胞浆抗体相关性血管炎（AAV）肺部受累患者至关重要。本研究旨在创建并内部验证一个AAV患者肺部受累死亡率的预后模型，该模型可提供个体化风险评估。
纳入2013年1月至2022年7月在南昌大学第二附属医院诊断为AAV的150例患者队列，使用从中国风湿病数据中心（CRDC）获得的数据。该模型采用Cox比例风险回归和最小绝对收缩和选择算子开发。为验证该模型，进行了区分度、校准评估，并通过决策曲线分析进行验证。
肺部受累AAV患者的平均生存时间为57.0±4.1个月。在最终的死亡预测模型中，纳入了四个临床变量：基线年龄、肿瘤病史、基线血红蛋白水平以及用力肺活量占正常预测值的百分比水平。建立了1年、2年和3年肺部受累AAV患者死亡率概率预测列线图。对该模型进行了内部验证，得出Harrell一致性指数为0.884，Brier评分为0.088，校准曲线表明性能令人满意。
我们利用易于获取的临床风险因素构建了一个风险模型，该模型可以准确预测AAV患者肺部受累相关的未来死亡风险。
