How to Define Boolean Low Disease Activity in Rheumatoid Arthritis: Experience from a Large Real-world Cohort.
How to Define Boolean Low Disease Activity in Rheumatoid Arthritis: Experience from a Large Real-world Cohort.
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如何定义类风湿关节炎的布尔低疾病活动性：来自真实世界大队列的经验。
DOI：
10.1007/s40744-020-00270-z
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发表时间：
2021-03
影响因子：
3.8
通讯作者：
Zhang Z
中科院分区：
文献类型：
--
作者：
Xie W;Li G;Huang H;Zhang Z
这项工作的目的是提出布尔定义的低疾病活动度（LDA），并测试其在类风湿关节炎（RA）中的效用。我们使用的数据来自北京大学第一医院10年来RA的纵向学术临床数据库。布尔定义的LDA的最初提议是以1为步长从2到5递增阈值（称为布尔-LDA 2/3/4/5）。分析基于指数的[简化疾病活动指数（SDAI）和临床疾病活动指数（CDAI）] LDA的一致性和残留肿胀关节计数（SJC）模式。为了证实发现，我们将RA患者以3：2的比例随机分为分析队列或验证队列。分析队列共纳入672例患者的4881次访视。在这些访视中，达到LDA的频率为71.9%（SDAI）、73.6%（CDAI）、52.8%（布尔-LDA 2）、65.2%（布尔-LDA 3）、73.5%（布尔-LDA 4）和80.7%（布尔-LDA 5）。在布尔-LDA 3中观察到与SDAI-LDA或CDAI-LDA的高一致性和相似的SJC模式（kappa = 0.796，0.771）。进一步的分析发现，符合SDAI-LDA而不是布尔-LDA 3的主要原因是患者的总体评估（PGA）评分较高（62.9%）。在布尔-LDA 3的进一步修改中，当仅将PGA截止值增加到4.0、4.5或用截止值为3.0的评价者总体评估（EGA）替换PGA时，与SDAI-LDA或CDAI-LDA达到更好的一致性。这些结果在随机生成的449例患者的3306次门诊访视中进一步重复。使用3作为布尔LDA的临界值，为基于指数的LDA提供了很大的临床实用性，特别是当专门将PGA临界值增加到4.0、4.5或用EGA替代PGA时，临界值为3.0。这可能值得在临床实践中加以考虑。在线版本包含补充材料，可通过10.1007/s40744-020-00270-z获得。
The aim of this work is to propose Boolean-defined low disease activity (LDA) and to test its utility in rheumatoid arthritis (RA). We used data from a longitudinal academic clinical database of RA in Peking University First Hospital over a decade. The initial proposal of Boolean-defined LDA was proposed with ascending thresholds from 2 to 5 in steps of 1 (referred to as Boolean-LDA2/3/4/5). Agreement and residual swollen joint count (SJC) pattern with the index-based [Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI)] LDA was analyzed. To confirm discovery, we randomly classified RA patients in a 3:2 ratio into either analysis cohort or validation cohort. In total, 4881 visits of 672 patients were included in the analysis cohort. Of these visits, the frequencies of achieving LDA were 71.9% (SDAI), 73.6% (CDAI), 52.8% (Boolean-LDA2), 65.2% (Boolean-LDA3), 73.5% (Boolean-LDA4), and 80.7% (Boolean-LDA5). High consistency and similar SJC pattern with SDAI-LDA or CDAI-LDA were observed in Boolean-LDA3 (kappa = 0.796, 0.771). Further analysis found meeting SDAI-LDA but not Boolean-LDA3 was largely attributable to higher patient’s global assessment (PGA) scores (62.9%). In further modification of Boolean-LDA3, better agreement with SDAI-LDA or CDAI-LDA was reached when exclusively increasing PGA cutoffs to 4.0, 4.5 or replacing PGA by evaluator’s global assessment (EGA) with cutoff to 3.0. These findings were further replicated in randomly generated validation cohort of 449 patients with 3306 clinic visits. Using cutoff of 3 to Boolean-LDA provides great clinical utility with index-based LDA, especially when exclusively increasing PGA cutoffs to 4.0, 4.5 or replacing PGA by EGA with cutoffs to 3.0. This may deserve being considered in clinical practice. The online version contains supplementary material available at 10.1007/s40744-020-00270-z.
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