A nomogram to predict the renal prognosis of patients with lupus nephritis
10.3760/cma.j.issn.1001-7097.2017.06.001
- VernacularTitle:狼疮肾炎患者肾脏预后预测列线图的建立
- Author:
Yuxi WU
;
Yuan PENG
;
Yan LIU
;
Dongni CHEN
;
Wei CHEN
;
Xueqing YU
- Keywords:
Lupus nephritis;
Prognosis;
Glomerular filtration rate;
Nomogram;
Treatment response
- From:
Chinese Journal of Nephrology
2017;33(6):401-409
- CountryChina
- Language:Chinese
-
Abstract:
Objective To develop a nomogram for the use of predicting renal outcomes of Chinese lupus nephritis (LN) patients.Methods From January 1,2005 to October 1,2015,513 patients with biopsy-proven LN in the First Affiliated Hospital of Sun Yat-Sen University were enrolled into this study.Renal outcomes were defined as end-stage renal disease or doubling of serum creatinine.Demographic characteristics,laboratory data,and pathologic data were recorded and included for analysis.Nomograms were designed using multivariate Cox proportional hazards regression to predict the non-outcome renal survival in 5 and 8 year according to the Akaike information criterion (AIC) and continuous reclassification net improvement (cNRI).Predictive accuracy and discriminative ability of the models were determined by concordance index (C-index) and calibration curve.Results During a median follow up of 48 (24,71) months,44 patients (8.58%) reached the endpoint.1-year,5-year and 8-year non-outcome renal survival were 97.57%,92.89%,79.89% respectively.According to multivariate Cox regression,four nomograms including index for baseline renal function,pathologic severity,and response to treatment were designed.The best model,within which included eGFR was lower than 30 ml · min-1 · (1.73 m2)-1(HR=4.44,95% CI 2.16-9.13,P < 0.01),percentage of global glomerulosclerosis was higher (HR=12.28,95%CI 3.58-42.13,P < 0.01) and partial remission occurred after 6-month induction treatment (HR=9.16,95% CI 4.71-17.82,P < 0.01) demonstrated good discrimination to predict 5-year and 8-year non-outcome renal survival [C-index,0.80(95%CI 0.81-0.91),0.76(95%CI 0.68-0.85),respectively].The nomogram based on above model also performed good calibration.Conclusion The nomogram based on patients' baseline eGFR,percentage of global glomerulosclerosis,and treatment reaction after 6-month induction therapy can accurately predict 5-year and 8-year non-outcome renal survival in Chinese lupus nephritis patients.