Exploration Of Predictive Indexes Of Lupus Nephritis Disease Activity

Objective:Lupus nephritis(LN)is the most common secondary glomerular disease in China.Despite continuous advance in treatment,10-20% of patients still have serious adverse events such as end-stage renal disease and death within 10 years.The pathological type and the evaluation of disease activity of LN patients are closely related to the survival time and prognosis of patients.Kidney biopsy is the gold standard for judging the patient's disease activity,but it is still difficult in clinical practice due to various subjective and objective factors.It is currently widely Accepted that the clinical evaluation system for LN disease activity is the systemic lupus erythematosus disease activity index 2000(SLEDAI 2000)at home and abroad,but its scoring items include clinical symptom and laboratory indicator of patients.The clinical symptom assessment is subjective,the laboratory indicator is more objective,and several studies in recent years have shown that there is a significant correlation between neutrophil/ lymphocyte ratio(NLR),platelet(PLT),albumin(ALB)and the activity of various autoimmune diseases;and there is also a lack of relevant research of correlation between lymphocyte(L)and LN disease activity.Therefore,this study attempts to analyze the correlation between LN clinical laboratory indicators,disease activity and clinicopathological indicators,and to explore simpler,more objective and practical predictor of LN disease activity to establish a clinical predictive model.Methods:A total of 131 patients with LN who were admitted to the Sichuan Provincial People's Hospital and underwent renal biopsy from June 2014 to May 2019 were included in the study.According to SLEDAI,LN patients were divided into LN activity subgroup(SLEDAI ? 10 points,94 cases)and LN stable subgroup(SLEDAI ? 9 points,37 cases).we collected the clinical and pathological data of the patients.Search for factors predicting the activity of LN patients used univariate logistic regression and multiple logistic regression analysis.Receiver operating characteristic curve evaluated the value of PLT and ALB in jointly predicting lupus nephritis activity.Results:1.Among the 131 patients,the mean age of onset was(41.70 ± 11.51)years old.The incidence of female was significantly higher than that of male(84% vs.16%,P <0.05);2.Renal damage was characterized by severe hematuria,large amounts of proteinuria,elevated serum creatinine,and elevated blood urea nitrogen in LN patients who had a high incidence of anemia,hypoalbuminemia and hypocomplementemia;3.The pathological types mainly included type ?-G,type ? and type ?;the incidence rate was 31 cases(23.66%),26 cases(19.84%),and 18 cases(13.74%),respectively,(P<0.05);4.NLR was positively correlated with serum creatinine,urea nitrogen level and SLEDAI(P<0.05).PLT,L and ALB were negatively correlated with serum creatinine,urea nitrogen and SLEDAI(P<0.05),and SLEDAI was positively correlated with AI(P<0.05);5.Logistic regression model analysis: univariate logistic regression analysis showed that thrombocytopenia,low C3,low C4,lymphocytopenia,anemia and hypoalbuminemia;hematuria and proteinuria;positive p-ANCA were risk factors for disease activity in LN patients.Multivariate logistic regression analysis of the above related factors revealed that albumin(OR = 0.891,P <0.01)and platelet(OR = 0.991,P <0.01)were protective factors for disease activity in patients with LN,namely hypoalbuminemia and thrombocytopenia were independent predictors of disease activity in LN patients;6.The ROC curve showed that the combined area under the ROC curve(AUC)of PLT?145.5x10^9/l and ALB?24.55g/l in the diagnosis of LN disease activity is 0.772 [95% CI(0.679,0.865),P <0.001],which is significantly higher than that of the independent prediction of each indicator,with the sensitivity of 59% and the specificity of 86%,with the largest predictive value and the highest accuracy.Conclusion:1.NLR,PLT,L and ALB were correlated with SLEDAI score to some extent,which can be used as an auxiliary indicator to evaluate the disease activity of LN;2.Thrombocytopenia and hypoalbuminemia were independent predictors of disease activity in LN patients.The combination of PLT?145.5x10^9/l and ALB?24.55g/l had the best predictive value and highest accuracy for LN disease activity,which was 72.5 percent,with 0.772 of AUC(P <0.001).3.LN patients with more thrombocytopenia or(and)more obvious albumin reduction may have higher disease activity,which prompted us that LN patients with thrombocytopenia and hypoalbuminemia should strengthen management and actively treat at the beginning of the diagnosis of LN.