Role of clinicopathological features for the early prediction of prognosis in lupus nephritis

被引:4
作者
Zhang, Ji [1 ,2 ]
Song, Hanlei [2 ,3 ]
Li, Duo [1 ,2 ]
Lv, Yinqiu [1 ,2 ]
Chen, Bo [1 ,2 ]
Zhou, Yin [1 ,2 ]
Ding, Xiaokai [1 ,2 ]
Chen, Chaosheng [1 ,2 ]
机构
[1] Wenzhou Med Univ, Affiliated Hosp 1, Dept Nephrol, Nanbaixiang St, Wenzhou 325000, Zhejiang, Peoples R China
[2] Wenzhou Med Univ, Inst Chron Kidney Dis, Wenzhou, Zhejiang, Peoples R China
[3] Ruian Peoples Hosp, Dept Nephrol, Wenzhou, Zhejiang, Peoples R China
关键词
Lupus nephritis; Prognosis; Interaction effect; Renal pathology; Proteinuria; Serum albumin; PROTEIN-LOSING ENTEROPATHY; TERM RENAL OUTCOMES; CLASSIFICATION; BIOPSY; DISEASE; CRITERIA; US;
D O I
10.1007/s12026-021-09201-8
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Ambiguities remain regarding the role of clinicopathological characteristics in the early prediction of the prognosis of lupus nephritis (LN). Systemic lupus erythematosus (SLE) patients who completed routine follow-up were identified and retrospectively reviewed for eligible cases. Poor prognosis was defined as all-cause mortality or a persistent decrease of eGFR greater than half the baseline level or progression to end-stage renal disease (ESRD). An optimal Cox regression model was constructed for the early prediction of a poor prognosis for LN. Among the 2163 SLE patients, 376 eligible LN cases were enrolled in the study, with a median follow-up time of 55 [27.0, 87.0] months. The male-to-female ratio was 1:7.2, and 37 patients (9.8%) progressed to the composite endpoint. The ISN/RPS class was significantly associated with proteinuria levels (P-value < 0.001), and class IV/IV + V patients, but not class V patients, had the most severe proteinuria. Our optimal multivariate Cox regression model indicated that sex, ISN/RPS class, tubular atrophy/interstitial fibrosis, serum albumin, tertiles of proteinuria, and their interaction were independently associated with a poor prognosis. ROC analysis and external validation demonstrated that our model was efficient and robust for distinguishing LN patients with a poor prognosis. Our study constructed a robust and early predictive model for convenience in clinical practice to identify poor prognosis in LN patients. We found a significant interaction effect between proteinuria and serum albumin for the prediction of poor prognosis. LN patients with low-level proteinuria and hypoalbuminemia exhibit an increased hazard of progression to poor outcomes.
引用
收藏
页码:285 / 294
页数:10
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