A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach.
A Longitudinal Analysis of Outcomes of Lupus Nephritis in an International Inception Cohort Using a Multistate Model Approach.
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DOI：
10.1002/art.39674
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Farewell V
中科院分区：
文献类型：
--
作者：
Hanly JG;Su L;Urowitz MB;Romero-Diaz J;Gordon C;Bae SC;Bernatsky S;Clarke AE;Wallace DJ;Merrill JT;Isenberg DA;Rahman A;Ginzler EM;Petri M;Bruce IN;Dooley MA;Fortin P;Gladman DD;Sanchez-Guerrero J;Steinsson K;Ramsey-Goldman R;Khamashta MA;Aranow C;Alarcón GS;Fessler BJ;Manzi S;Nived O;Sturfelt GK;Zoma AA;van Vollenhoven RF;Ramos-Casals M;Ruiz-Irastorza G;Lim SS;Kalunian KC;Inanc M;Kamen DL;Peschken CA;Jacobsen S;Askanase A;Theriault C;Farewell V
使用多状态建模方法研究狼疮性肾炎 (LN) 中估计肾小球滤过率 (GFR) 和蛋白尿的双向变化及其变化的预测因素。系统性狼疮国际合作诊所初始队列中的患者每年被分为估计 GFR 状态 1（>60 毫升/分钟）、状态 2（30-60 毫升/分钟）或状态 3（<30 毫升/分钟）以及估计蛋白尿状态 1（<0.25 克/天）、状态 2（0.25-3.0 克/天）或状态 3（>3.0 克/天），或终末期肾病（ESRD）或死亡。使用多状态建模，状态之间的相对转换率表明改善和恶化。在 1,826 名狼疮患者中，700 名 (38.3%) 出现狼疮性肾炎。在 5.2 ± 3.5 年的平均值 ± SD 随访期间，估计 GFR 和估计蛋白尿改善的可能性大于恶化的可能性。 5 年后，62% 最初处于估计 GFR 状态 3 的患者和 11% 最初处于估计蛋白尿状态 3 的患者转变为 ESRD。对于估计的 GFR，保持初始状态 1、2 和 3 的概率分别为 85%、11% 和 3%；对于估计的蛋白尿，保持初始状态 1、2 和 3 的概率分别为 62%、29% 和 4%。男性预测估计 GFR 状态会有所改善；年龄较大、种族/民族、较高的估计蛋白尿状态和较高的肾活检慢性评分预示着病情恶化。对于估计的蛋白尿、种族/族裔、较早的日历年、无肾脏变量的损伤评分以及较高的肾活检慢性评分预测恶化；男性、狼疮抗凝剂的存在、V 类肾炎和霉酚酸的使用预测改善较小。在 LN 中，肾脏结果的预期改善或恶化可以通过多状态模型来估计，并且先于可识别的风险因素。新的 LN 治疗干预措施应该达到或超过这些预期。
To study bidirectional change and predictors of change in estimated glomerular filtration rate (GFR) and proteinuria in lupus nephritis (LN) using a multistate modeling approach. Patients in the Systemic Lupus International Collaborating Clinics inception cohort were classified annually into estimated GFR state 1 (>60 ml/minute), state 2 (30–60 ml/minute), or state 3 (<30 ml/minute) and estimated proteinuria state 1 (<0.25 gm/day), state 2 (0.25–3.0 gm/day), or state 3 (>3.0 gm/day), or end-stage renal disease (ESRD) or death. Using multistate modeling, relative transition rates between states indicated improvement and deterioration. Of 1,826 lupus patients, 700 (38.3%) developed LN. During a mean ± SD follow-up of 5.2 ± 3.5 years, the likelihood of improvement in estimated GFR and estimated proteinuria was greater than the likelihood of deterioration. After 5 years, 62% of patients initially in estimated GFR state 3 and 11% of patients initially in estimated proteinuria state 3 transitioned to ESRD. The probability of remaining in the initial states 1, 2, and 3 was 85%, 11%, and 3%, respectively, for estimated GFR and 62%, 29%, and 4%, respectively, for estimated proteinuria. Male sex predicted improvement in estimated GFR states; older age, race/ethnicity, higher estimated proteinuria state, and higher renal biopsy chronicity scores predicted deterioration. For estimated proteinuria, race/ethnicity, earlier calendar years, damage scores without renal variables, and higher renal biopsy chronicity scores predicted deterioration; male sex, presence of lupus anticoagulant, class V nephritis, and mycophenolic acid use predicted less improvement. In LN, the expected improvement or deterioration in renal outcomes can be estimated by multistate modeling and is preceded by identifiable risk factors. New therapeutic interventions for LN should meet or exceed these expectations.
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影响因子：
2.6
作者：
Cooper, GS;Parks, CG;Dooley, MA
通讯作者：
Dooley, MA
DOI：
10.1016/0021-9681(55)90018-7
发表时间：
1955-01-01
期刊：
Journal of chronic diseases
影响因子：
--
作者：
MERRELL, M;SHULMAN, L E
通讯作者：
SHULMAN, L E
影响因子：
--
作者：
Hanly, J. G.;Urowitz, M. B.;Merrill, J. T.
通讯作者：
Merrill, J. T.
影响因子：
5.5
作者：
Croca, Sara C.;Rodrigues, Teresa;Isenberg, David A.
通讯作者：
Isenberg, David A.
影响因子：
27.4
作者：
Bruce IN;O'Keeffe AG;Farewell V;Hanly JG;Manzi S;Su L;Gladman DD;Bae SC;Sanchez-Guerrero J;Romero-Diaz J;Gordon C;Wallace DJ;Clarke AE;Bernatsky S;Ginzler EM;Isenberg DA;Rahman A;Merrill JT;Alarcón GS;Fessler BJ;Fortin PR;Petri M;Steinsson K;Dooley MA;Khamashta MA;Ramsey-Goldman R;Zoma AA;Sturfelt GK;Nived O;Aranow C;Mackay M;Ramos-Casals M;van Vollenhoven RF;Kalunian KC;Ruiz-Irastorza G;Lim S;Kamen DL;Peschken CA;Inanc M;Urowitz MB
通讯作者：
Urowitz MB