Factors associated with poor outcomes in patients with lupus nephritis
Factors associated with poor outcomes in patients with lupus nephritis
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DOI：
10.1191/0961203305lu2238oa
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发表时间：
2005-01-01
期刊：
影响因子：
2.6
通讯作者：
Estrada, HG
中科院分区：
文献类型：
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作者：
Contreras, G;Pardo, V;Estrada, HG
本研究的目的是通过对213例狼疮性肾炎患者的病例对照研究，确定与重要临床结局相关的因素。包括47%的西班牙裔，44%的非洲裔美国人和9%的高加索人，平均年龄为28岁。在平均37个月的随访期间，54例（25%）患者达到了血清肌酐加倍、终末期肾病或死亡的主要复合结局。34%的非洲裔美国人、20%的西班牙裔美国人和10%的白人达到了主要复合结局（P < 0.05）。达到复合结局的患者主要为增生性狼疮性肾炎（WHO分类：活动指数评分较高者分别为III级30%、IV级32%、V级18%和11级5%，P < 0.025（7 +/- 6 vs 5 +/- 5，P < 0.05），慢性指数（CI）评分（4 +/- 3 vs 2 +/- 2单位，P < 0.025），基线平均动脉压（MAP）较高（111 +/- 21 vs 102 +/- 14 mmHg，P < 0.025）和血清肌酐（1.9 ± 1.3 vs 1.3 ± 1.0 mg/dL，P < 0.025），但基线红细胞压积较低（29 +/- 6对31 ± 5%P < 0.025）和补体C3（54 +/- 26对65 ± 33 mg/dL，P < 0.025）。与对照组相比，达到复合结局的患者中有更多的肾病范围蛋白尿（74%对56%，P < 0.025）。通过多变量分析，CI（风险比[95% CI] 1.18 [1.07-1.30]/点）、MAP（HR 1.02 [1.00-1.03]/mmHg）和基线血清肌酐（HR 1.26 [1.04-1.54]/mg/dL）与复合结局独立相关。我们的结论是高血压和肾活检时血清肌酐升高以及高CI与狼疮性肾炎患者慢性肾功能衰竭或死亡风险增加相关。
The objective of this study was to identify the factors associated with important clinical outcomes in a case-control study of 213 patients with lupus nephritis. Included were 47% Hispanics, 44% African Americans and 9% Caucasians with a mean age of 28 years. Fifty-four (25%) patients reached the primary composite outcome of doubling serum creatinine, end-stage renal disease or death during a mean follow-up of 37 months. Thirty-four percent African Americans, 20% Hispanics and 10% Caucasians reached the primary composite outcome (P < 0.05). Patients reaching the composite outcome had predominantly proliferative lupus nephritis (WHO classes: 30% III, 32% IV, 18% V and 5% 11, P < 0.025) with higher activity index score (7 +/- 6 versus 5 +/- 5, P < 0.05), chronicity index (CI) score (4 +/- 3 versus 2 +/- 2 unit, P < 0.025), higher baseline mean arterial pressure (MAP) (111 +/- 21 versus 102 +/- 14 mmHg, P < 0.025) and serum creatinine (1.9 +/- 1.3 versus 1.3 +/- 1.0 mg/dL, P < 0.025), but lower baseline hematocrit (29 +/- 6 versus 31 + 5% P < 0.025) and complement C3 (54 +/- 26 versus 65 + 33 mg/dL, P < 0.025) compared to controls. More patients reaching the composite outcome had nephrotic range proteinuria compared to controls (74% versus 56%, P < 0.025). By multivariate analysis, CI (hazard ratio [95% CI] 1.18 [1.07-1.30] per point), MAP (HR 1.02 [1.00-1.03] per mmHg), and baseline serum creatinine (HR 1.26 [1.04-1.54] per mg/dL) were independently associated with the composite outcome. We concluded that hypertension and elevated serum creatinine at the time of the kidney biopsy as well as a high CI are associated with an increased the risk for chronic renal failure or death in patients with lupus nephritis.