A nomogram to predict the renal prognosis of patients with lupus nephritis / 中华肾脏病杂志

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.