Prognostic nomogram and score to predict renal survival of patients with biopsy-proven diabetic nephropathy
Prognostic nomogram and score to predict renal survival of patients with biopsy-proven diabetic nephropathy
复制标题
用于预测活检证实的糖尿病肾病患者肾存活的预后列线图和评分
DOI：
10.1016/j.diabres.2019.107809
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发表时间：
2019-09-01
影响因子：
5.1
通讯作者：
Li, Wenge
中科院分区：
文献类型：
--
作者：
Jiang, Shimin;Yu, Tianyu;Li, Wenge
目的：目前缺乏准确预测糖尿病肾病（DN）终末期肾脏疾病的临床和病理标志物。本研究旨在建立一个有效的预后诺模图和肾存活率（RS）评分活检证实的DN。方法：分析来自110例DN患者进行肾活检在中日友谊医院2006年1月至2018年5月之间，DN作为唯一的肾小球疾病诊断。采用单变量和多变量考克斯回归分析评估34个基线临床病理参数的预后能力。使用校准曲线和一致性指数（C指数）测量最终模型的预测准确性和区分能力。内部验证模型进行了评估，使用bootstrap resstriation.Results：尿蛋白排泄，慢性肾脏疾病，肾小球玻璃样变性，毛细血管外细胞增生的阶段是RS的独立预后因素，所有被选入诺模图。生存概率的校准曲线显示诺模图的预测与实际观察之间具有良好的一致性。预测生存的C指数为0.79（95%置信区间（CI）0.72-0.86）。0.76的高C指数值表明内部验证良好。预后评分有可能划定两个预后组的中位数RS为24和70 months.Conclusions：建议诺模图和评分提供了一个有用的个性化的风险估计DN患者的肾脏预后。(C)2019爱思唯尔B. V.保留所有权利。
Aims: Both clinical and pathogenetic markers for accurate prediction of end-stage renal disease in diabetic nephropathy (DN) are lacking. This study aimed to establish an effective prognostic nomogram and a score for renal survival (RS) in biopsy-proven DN.Methods: Analyses were derived from 110 DN patients who underwent renal biopsy at China-Japan Friendship Hospital between January 2006 and May 2018 with DN as the only glomerular disease diagnosis. The prognostic ability of 34 baseline clinicopathologic parameters was evaluated using univariate and multivariate Cox regression analyses. The predictive accuracy and discriminative ability of the final model were measured using the calibration curve and concordance index (C-index). Internal validation of the model was assessed using bootstrap resampling.Results: Urinary proteinuria excretion, stages of chronic kidney disease, glomerular hyalinosis, and extracapillary hypercellularity were independent prognostic factors for RS, and all were selected into the nomogram. The calibration curve for the probability of survival showed good agreement between the prediction by nomogram and actual observation. The C-index for predicting survival was 0.79 (95% confidence interval (CI) 0.72-0.86). A high C-index value of 0.76 indicated good internal validation. The prognostic score had the potential to delineate two prognosis groups with median RS of 24 and 70 months, respectively.Conclusions: The proposed nomogram and score provide a useful individualized risk estimate of renal prognosis in patients with DN. (C) 2019 Elsevier B.V. All rights reserved.