DERIVATION OF THE SLEDAI - A DISEASE-ACTIVITY INDEX FOR LUPUS PATIENTS
DERIVATION OF THE SLEDAI - A DISEASE-ACTIVITY INDEX FOR LUPUS PATIENTS
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DOI：
10.1002/art.1780350606
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发表时间：
1992-06-01
影响因子：
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通讯作者：
CHANG, CH
中科院分区：
文献类型：
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作者：
BOMBARDIER, C;GLADMAN, DD;CHANG, CH
目标。目的：规范系统性红斑狼疮(SLE)的预后指标。确定了三个可以充分描述结果的指标(疾病活动、疾病损害和健康状况)；我们在这里描述了疾病活动指数的发展。24个变量被确定为疾病活动指数中的重要因素。这些被用来生成574名患者的档案，14名风湿病医生对这些档案进行了疾病活动性评分，评分范围为0-10。第二次评分为10分，得到的分数与第一次没有显著差异，表明经验丰富的临床医生可以可靠地对疾病活动做出全球估计。多元回归模型被用来估计24个临床变量在医生对疾病活动的全球评级中的相对重要性。这些评估是在75%的医生评分的“训练集”上进行的，然后在“测试集”上进行验证，测试集包括剩下的25%的医生评分。训练集内模型的解释力较高(R2=0.93)。这些模型对器官系统的回归系数进行了简化，以便于临床使用。这产生了SLE疾病活动性的9个器官系统的“加权”指数，即SLEDAI，如下：中枢神经系统和血管8个，肾脏和肌肉骨骼4个，血清、皮肤、免疫学2个，体质和血液学1个。最高理论得分为105分，但实际上，很少有患者的得分高于45分。SLEDAI量表对医生在测试集中的评分有较好的预测性(皮尔逊相关系数=0.64~0.79)。SLEDAI是经验丰富的临床医生对狼疮疾病活动性的全球评估的有效模型。它代表了狼疮研究领域的一组专家的共识。
Objective. To standardize outcome measures in systemic lupus erythematosus (SLE). Three indices were identified which could adequately describe outcome (disease activity, damage from disease, and health status); we describe here the development of the Disease Activity Index.Methods. Twenty-four variables were identified as important factors in a disease activity index. These were used to generate 574 patient profiles, which were rated on a disease activity scale of 0-10 by 14 rheumatologists. A second rating of 10 of the profiles yielded scores that were not significantly different from the first, indicating that experienced clinicians can reliably make global estimates of disease activity. Multiple regression models were used to estimate the relative importance of the 24 clinical variables in the physicians' global rating of disease activity. These were estimated on a "training set" of 75% of physicians' ratings, and then validated on a "testing set," consisting of the remaining 25% of physicians' ratings.Results. The explanatory power of the models in the training set was high (R2 = 0.93). The models' regression coefficients for the organ systems were simplified for easier use in clinical practice. This generated a "weighted" index of 9 organ systems for disease activity in SLE, the SLEDAI, as follows: 8 for central nervous system and vascular, 4 for renal and musculoskeletal, 2 for serosal, dermal, immunologic, and 1 for constitutional and hematologic. The maximum theoretical score is 105, but in practice, few patients have scores greater than 45. The SLEDAI predicted well the physicians' ratings in the testing set (Pearson's correlation coefficients = 0.64-0.79).Conclusion. The SLEDAI is a validated model of experienced clinicians' global assessments of disease activity in lupus. It represents the consensus of a group of experts in the field of lupus research.