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The Improved Kidney Risk Score in ANCA-Associated Vasculitis for Clinical Practice and Trials
S. Bate, D. McGovern, F. Costigliolo, PG. Tan, V. Kratky, J. Scott, GB. Chapman, N. Brown, L. Floyd, B. Brilland, E. Martín-Nares, MF. Aydın, D. Ilyas, A. Butt, E. Nic An Riogh, M. Kollar, JS. Lees, A. Yildiz, A. Hinojosa-Azaola, A. Dhaygude, SA....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články
Grantová podpora
Wellcome Trust - United Kingdom
222061/Z/20/Z
Wellcome Trust - United Kingdom
NLK
Free Medical Journals
od 1990 do Před 1 rokem
PubMed Central
od 2008 do Před 1 rokem
Europe PubMed Central
od 2008 do Před 1 rokem
Open Access Digital Library
od 1990-07-01
- MeSH
- ANCA-asociované vaskulitidy * diagnóza MeSH
- atrofie MeSH
- fibróza MeSH
- kreatinin MeSH
- ledviny MeSH
- lidé středního věku MeSH
- lidé MeSH
- longitudinální studie MeSH
- protilátky proti cytoplazmě neutrofilů * MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
SIGNIFICANCE STATEMENT: Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. More than 1500 patients were collated in an international longitudinal study to revise the ANCA kidney risk score. The score showed satisfactory performance, mimicking the original study (Harrell's C=0.779). In the development cohort of 959 patients, no additional parameters aiding the tool were detected, but replacing the GFR with creatinine identified an additional cutoff. The parameter interstitial fibrosis and tubular atrophy was modified to allow wider access, risk points were reweighted, and a fourth risk group was created, improving predictive ability (C=0.831). In the validation, the new model performed similarly well with excellent calibration and discrimination ( n =480, C=0.821). The revised score optimizes prognostication for clinical practice and trials. BACKGROUND: Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. A retrospective international longitudinal cohort was collated to revise the ANCA renal risk score. METHODS: The primary end point was ESKD with patients censored at last follow-up. Cox proportional hazards were used to reweight risk factors. Kaplan-Meier curves, Harrell's C statistic, receiver operating characteristics, and calibration plots were used to assess model performance. RESULTS: Of 1591 patients, 1439 were included in the final analyses, 2:1 randomly allocated per center to development and validation cohorts (52% male, median age 64 years). In the development cohort ( n =959), the ANCA renal risk score was validated and calibrated, and parameters were reinvestigated modifying interstitial fibrosis and tubular atrophy allowing semiquantitative reporting. An additional cutoff for kidney function (K) was identified, and serum creatinine replaced GFR (K0: <250 μ mol/L=0, K1: 250-450 μ mol/L=4, K2: >450 μ mol/L=11 points). The risk points for the percentage of normal glomeruli (N) and interstitial fibrosis and tubular atrophy (T) were reweighted (N0: >25%=0, N1: 10%-25%=4, N2: <10%=7, T0: none/mild or <25%=0, T1: ≥ mild-moderate or ≥25%=3 points), and four risk groups created: low (0-4 points), moderate (5-11), high (12-18), and very high (21). Discrimination was C=0.831, and the 3-year kidney survival was 96%, 79%, 54%, and 19%, respectively. The revised score performed similarly well in the validation cohort with excellent calibration and discrimination ( n =480, C=0.821). CONCLUSIONS: The updated score optimizes clinicopathologic prognostication for clinical practice and trials.
1st Faculty of Medicine Charles University Prague Czechia
Department of Internal Medicine and IRCCS Ospedale Policlinico San Martino Genova Italy
Department of Medicine University of Cambridge Cambridge United Kingdom
Department of Nephrology General University Hospital Prague Czechia
Department of Pathology Groningen University Medical Center Groningen The Netherlands
Department of Pathology Institute for Clinical and Experimental Medicine Prague Czechia
Department of Pathology Johns Hopkins University School of Medicine Baltimore Maryland
Department of Renal Medicine Vasculitis Clinic Addenbrooke's Hospital Cambridge United Kingdom
Division of Cardiovascular Sciences University of Manchester Manchester United Kingdom
Division of Nephrology Bursa Uludağ University School of Medicine Bursa Turkey
Division of Nephrology Dialysis and Transplantation University of Genova Genova Italy
Division of Nephrology Johns Hopkins University School of Medicine Baltimore Maryland
Glasgow Renal and Transplant Unit Queen Elizabeth University Hospital Glasgow United Kingdom
Renal Unit Northern Health Victoria Australia
School of Cardiovascular and Metabolic Health University of Glasgow Glasgow United Kingdom
Service de Néphrologie Dialyse Transplantation CHU d'Angers Angers France
Trinity Kidney Centre Trinity College Dublin Dublin Ireland
University Medical Center Hamburg Eppendorf Institute of Pathology Hamburg Germany
Citace poskytuje Crossref.org
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