Pretreatment mortality risk prediction model in patients with polymyositis/dermatomyositis-associated interstitial
Xianhua Gui1, Wangzhong Li2, Hanyi Jiang1
1Department of Respiratory Medicine, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China.
Objectives:
Risk prediction for patients with polymyositis/dermatomyositis-associated interstitial lung disease (PM/DM-ILD) is challenging due to heterogeneity in the disease course. We aimed to develop a mortality risk prediction model for PM/DM-ILD.
Methods:
This prognostic study analysed patients with PM/DM-ILD admitted to Nanjing Drum Hospital from 2016 to 2021. The primary outcome was mortality within 1 year. We used a least absolute shrinkage and selection operator (LASSO) logistic regression model to identify predictive laboratory indicators. These indicators were used to create a laboratory risk score, and we developed a mortality risk prediction model by incorporating clinical factors. The evaluation of model performance encompassed discrimination, calibration, clinical utility and practical application for risk prediction and prognosis.
Results:
Overall, 418 patients with PM/DM-ILD were enrolled and randomly divided into development (n=282) and validation (n=136) cohorts. LASSO logistic regression identified four optimal features in the development cohort, forming a laboratory risk score: C reactive protein, lactate dehydrogenase, CD3+CD4+ T cell counts and PO2/FiO2. The final prediction model integrated age, arthralgia, anti-melanoma differentiation-associated gene 5 antibody status, high-resolution CT pattern and the laboratory risk score. The prediction model exhibited robust discrimination (area under the receiver operating characteristic: 0.869, 95% CI 0.811 to 0.910), excellent calibration and valuable clinical utility. Patients were categorised into three risk groups with distinct mortality rates. The internal validation, sensitivity analyses and comparative assessments against previous models further confirmed the robustness of the prediction model.
Conclusions:
We developed and validated an evidence-based mortality risk prediction model with simple, readily accessible clinical variables in patients with PM/DM-ILD, which may inform clinical decision-making.
Insights
A new model predicts mortality risk in polymyositis/dermatomyositis-associated interstitial lung disease (PM/DM-ILD) patients. This tool uses simple clinical data to aid decision-making for better patient outcomes.
Area of Science:
- Rheumatology
- Pulmonology
- Medical Informatics
Background:
- Polymyositis/dermatomyositis-associated interstitial lung disease (PM/DM-ILD) presents a challenge for risk prediction due to varied disease progression.
- Accurate mortality risk assessment is crucial for effective management of PM/DM-ILD patients.
Purpose of the Study:
- To develop and validate a reliable mortality risk prediction model for patients diagnosed with PM/DM-ILD.
- To identify key clinical and laboratory indicators for predicting mortality in PM/DM-ILD.
Main Methods:
- A prognostic study involving 418 PM/DM-ILD patients from 2016-2021.
- Utilized Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression to identify predictive laboratory markers.
- Developed a comprehensive model integrating laboratory risk score with clinical factors for mortality prediction.
Main Results:
- Identified four key laboratory indicators: C-reactive protein, lactate dehydrogenase, CD3+CD4+ T-cell counts, and PO2/FiO2 ratio.
- The final model, incorporating age, arthralgia, anti-MDA5 status, CT patterns, and lab score, demonstrated strong predictive performance (AUROC 0.869).
- The model effectively stratified patients into three distinct risk groups with varying mortality rates.
Conclusions:
- An evidence-based, validated mortality risk prediction model for PM/DM-ILD was successfully developed.
- The model employs accessible clinical variables, facilitating informed clinical decision-making and prognosis.
- This tool offers practical utility for assessing and managing PM/DM-ILD patient risk.
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