Systemic lupus international collaborating clinics renal activity/response exercise -: Comparison of agreement in rating renal response
Systemic lupus international collaborating clinics renal activity/response exercise -: Comparison of agreement in rating renal response
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DOI：
10.1002/art.23802
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发表时间：
2008-06-01
影响因子：
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通讯作者：
Zoma, Asad
中科院分区：
文献类型：
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作者：
Petri, Michelle;Kasitanon, Nuntana;Zoma, Asad
Objective.评估医生在评价狼疮性肾炎治疗反应时彼此的一致程度以及与3种现有反应指数的一致程度。来自125对访视（间隔6个月）的狼疮肾炎患者病历用于创建肾反应场景。7名肾病学家和22名风湿病学家将每种情况分为完全缓解、部分缓解、相同或恶化。将医生对肾脏反应的多个（最常见）评级与不列颠群岛狼疮评估组（BILAG）指数（原始和更新[2004]版）和红斑狼疮反应者指数（步枪）的肾脏部分计算的评分进行比较。通过计算组内相关系数（ICC）来评估医生之间的一致性程度。多个医生评级和评级之间的协议程度与建立的反应指数进行了评估，使用kappa矩阵。所有内科医生的ICC为0.64（肾脏科医生为0.62，风湿科医生为0.67）。机会调整的一致性度量多个医师评分和使用建立的指数获得的计算得分之间的（kappa系数）为0.50（95%置信区间[95% CI] 0.38-0.61），步枪为0.14 BILAG 2004年版为0.23（95%CI 0.21-0.44）。结论这些结果表明，作为一个群体，风湿病学家和肾脏病学家作为一个群体，有平等的协议，在他们的评级肾脏反应。多个医生评级与使用步枪的肾脏组件获得的评级之间存在中度一致性。使用基于原始BILAG的指数进行的反应评级与多个医生评级没有很好的一致性。
Objective. To assess the degree to which physicians agree with each other and with ratings obtained with 3 existing responder indices, in rating the response to treatment of lupus nephritis.Methods. Lupus nephritis patient medical records from 125 pairs of visits (6 months apart) were used to create renal response scenarios. Seven nephrologists and 22 rheumatologists rated each scenario as demonstrating complete response, partial response, same, or worsening. The plurality (most frequent) rating of renal response by the physicians was compared with the calculated score from the renal component of the British Isles Lupus Assessment Group (BILAG) index (original and updated [2004] version) and of the Responder Index for Lupus Erythematosus (RIFLE). The degree of agreement among the physicians was assessed by calculating intraclass correlation coefficients (ICCs). The degree of agreement between the plurality physician rating and ratings obtained with the established response indices was assessed using the kappa statistic.Results. The ICC among all physicians was 0.64 (0.62 for nephrologists and 0.67 for rheumatologists). The chance-adjusted measure of agreement (kappa coefficient) between the plurality physician rating and the calculated score obtained using established indexes was 0.50 (95% confidence interval [95% CI] 0.38-0.61) for the RIFLE, 0.14 (95% CI 0.03-6.25) for the original BILAG, and 0.23 (95% CI 0.21-0.44) for the BILAG 2004.Conclusion. These findings indicate that rheumatologists as a group and nephrologists as a group have equal agreement in their rating of renal response. There was moderate agreement between plurality physician ratings and ratings obtained using the renal component of the RIFLE. Ratings of response using an index based on the original BILAG did not have good agreement with the plurality physician rating.