Validation of the Antineutrophil Cytoplasmic Antibody Renal Risk Score and Modification of the Score in a Chinese Cohort With a Majority of Myeloperoxidase-Positive Patients

Anqi Ni; Liangliang Chen; Lan Lan; Yaomin Wang; Pingping Ren; Yilin Zhu; Ying Xu; Xiaoqi Shen; Qin Zhou; Xiaohan Huang; Huiping Wang; Jianghua Chen; Fei Han

doi:10.3899/jrheum.220818

Validation of the Antineutrophil Cytoplasmic Antibody Renal Risk Score and Modification of the Score in a Chinese Cohort With a Majority of Myeloperoxidase-Positive Patients

J Rheumatol. 2023 May;50(5):662-670. doi: 10.3899/jrheum.220818. Epub 2023 Jan 15.

Authors

Anqi Ni^#¹, Liangliang Chen^#¹, Lan Lan¹, Yaomin Wang¹, Pingping Ren¹, Yilin Zhu¹, Ying Xu¹, Xiaoqi Shen¹, Qin Zhou¹, Xiaohan Huang¹, Huiping Wang¹, Jianghua Chen¹, Fei Han²

Affiliations

¹ A. Ni, MD, L. Chen, MD, L. Lan, MD, Y. Wang, MD, P. Ren, MD, Y. Zhu, MD, Y. Xu, MD, X. Shen, MD, Q. Zhou, MD, X. Huang, MD, H. Wang, MD, J. Chen, MD, F. Han, MD, Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, and Institute of Nephrology, Zhejiang University, and Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, and Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, Zhejiang, China.
² A. Ni, MD, L. Chen, MD, L. Lan, MD, Y. Wang, MD, P. Ren, MD, Y. Zhu, MD, Y. Xu, MD, X. Shen, MD, Q. Zhou, MD, X. Huang, MD, H. Wang, MD, J. Chen, MD, F. Han, MD, Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, and Institute of Nephrology, Zhejiang University, and Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, and Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Hangzhou, Zhejiang, China. hanf8876@zju.edu.cn.

^# Contributed equally.

PMID: 36642437
DOI: 10.3899/jrheum.220818

Abstract

Objective: We aimed to validate and modify the renal risk score for antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN) in a Chinese cohort with a majority of myeloperoxidase (MPO)-positive patients.

Methods: A total of 285 patients with biopsy-proven AAGN in our center were retrospectively included. Patients were randomly assigned to the development set (n = 201) and the validation set (n = 84). We calculated the renal risk score and analyzed the clinicopathological characteristics and follow-up data. The nomogram was constructed based on the independent prognostic factors identified by the multivariable Cox regression and then compared with the renal risk score.

Results: Over a median follow-up period of 41.3 (range 20.0-63.8) months, 84 (29.5%) patients reached end-stage kidney disease (ESKD). In the development set, hypertension (hazard ratio [HR] 2.16, 95% CI 1.08-4.32, P = 0.03), high serum creatinine (HR 1.002, 95% CI 1.001-1.003, P < 0.001), high daily urine protein (HR 1.34, 95% CI 1.15-1.57, P < 0.001), high glomerular sclerosis (HR 13.98, 95% CI 3.50-55.92, P < 0.001), and interstitial fibrosis > 50% (HR 4.18, 95% CI 1.90-9.19, P < 0.001) were independent risk factors for ESKD, and these indicators were included in the nomogram. The C-indices of the nomogram model in the development set, validation set, and all-data set were 0.838 (range 0.785-0.891), 0.794 (range 0.774-0.814), and 0.822 (range 0.775-0.869), respectively, which were higher than those of the renal risk score model, 0.801 (range 0.748-0.854), 0.746 (range 0.654-0.838) and 0.783 (range 0.736-0.830), respectively. The net reclassification improvement and the integrated discrimination improvement further illustrated the higher predictive ability of the nomogram.

Conclusion: We present a nomogram as a practical tool to predict renal outcomes in Chinese patients with MPO-ANCA glomerulonephritis.

Keywords: antineutrophil cytoplasmic antibody; end-stage kidney disease; prognosis; vasculitis.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis*
Antibodies, Antineutrophil Cytoplasmic
East Asian People
Glomerulonephritis* / pathology
Humans
Kidney Failure, Chronic*
Peroxidase
Prognosis
Retrospective Studies
Risk Factors

Substances

Antibodies, Antineutrophil Cytoplasmic
Peroxidase