A multi-state Markov model study to estimate organ damage progression and influencing factors in systemic lupus erythematosus patients
10.16352/j.issn.1001-6325.2025.06.0800
- VernacularTitle:基于多状态马尔科夫模型预估系统性红斑狼疮患者器官受损进展及影响因素
- Author:
Lu LI
1
;
Liangming LI
;
Bing YU
;
Mengtao LI
;
Yanhong WANG
Author Information
1. 中国医学科学院基础医学研究所北京协和医学院基础学院流行病与卫生统计学系,北京 100005
- Keywords:
systemic lupus erythematosus;
multi-state Markov model;
transition probability
- From:
Basic & Clinical Medicine
2025;45(6):800-806
- CountryChina
- Language:Chinese
-
Abstract:
Objective To establish a multi-state Markov model of systemic lupus erythematosus(SLE)for patients in China and to explore the transition rule of organ damage accumulation and possible factors affecting the transition between states.Methods A retrospective cohort study was conducted using the data from CSTAR.The Systemic Lu-pus International Collaborating Clinics/American College of Rheumatology Damage Index(SDI)was divided into five irreversible disease states(SDI=0,1,2,≥3,and death,marked as S0,S1,S2,S3,Death).The R"mstate"package was used for statistical analysis.Results This study included 23 926 cases of SLE patients with cumulative follow-up of 12 030 visits.Among these patients,21 070 patients had no any organ damage at baseline.At the follow-up period,the transition probabilities of organ damage of S0→S1,S1→S2,S2→S3,S3→Death were 7.01％,12.58％,10.64％,and 12.19％,respectively.The multi-state Markov model showed that age,gender,disease dura-tion,SLEDAI score,corticosteroid dosage,and involvement of major organs were associated with the transition of or-gan damage status,each 1 year increased was associated with a 2％～3％increase in risk of damage accumulation risk(P＜0.01).Also,neurological(S0→S 1:HR=1.34;S1 →S2:HR=1.53;S2→S3:HR=1.73),cardiopulmonary(S0→S1:HR=3.66;S 1→S2:HR=1.51;S2→S3:HR=1.52),renal(S0→S 1:HR=1.24)and hematological involvement(S0→S1:HR=1.24)might be the risk factors.Conclusions The probability of organ damage accumulation in SLE pa-tients increases over time.Therefore,in the early stage of the disease,the involvement of important organs needs to be minimized and the treatment strategy should be dynamically adjusted at different stages of treatment.
