Development and internal validation of a model to predict long-term survival of ANCA associated vasculitis

Abstract

Objectives Risk stratification and prognosis prediction are critical for appropriate management of anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). Herein, we aim to develop and internally validate a prediction model specifically for long-term survival of patients with AAV. Methods We thoroughly reviewed the medical charts of patients with AAV admitted to Peking Union Medical College Hospital from January 1999 to July 2019. The Least Absolute Shrinkage and Selection Operator method and the COX proportional hazard regression was used to develop the prediction model. The Harrell's concordance index (C-index), calibration curves and Brier scores were calculated to evaluate the model performance. The model was internally validated by bootstrap resampling methods. Results A total of 653 patients were included in the study, including 303 patients with microscopic polyangiitis, 245 patients with granulomatosis with polyangiitis and 105 patients with eosinophilic granulomatosis with polyangiitis, respectively. During a median follow-up of 33 months (interquartile range 15–60 months), 120 deaths occurred. Age at admission, chest and cardiovascular involvement, serum creatinine grade, hemoglobin levels at baseline and AAV sub-types were selected as predictive parameters in the final model. The optimism-corrected C-index and integrated Brier score of our prediction model were 0.728 and 0.109. The calibration plots showed fine agreement between observed and predicted probability of all-cause death. The decision curve analysis (DCA) showed that in a wide range of threshold probabilities, our prediction model had higher net benefits compared with the revised five factor score (rFFSand) and the birmingham vasculitis activity score (BVAS) system. Conclusion Our model performs well in predicting outcomes of AAV patients. Patients with moderate-to-high probability of death should be followed closely and personalized monitoring plan should be scheduled.

Risk prediction model for mortality in microscopic polyangiitis: multicentre REVEAL cohort study

“…The French Vasculitis Study Group Relapse Score, which previously assessed the probability of relapse in patients with MPA and granulomatosis with polyangiitis (GPA), has been reported [23], as has RPM aimed at predicting cardiovascular events during a 5-year period following the onset of MPA and GPA [24]. Concerning the RPM to predict life prognosis, Chen et al proposed a unique RPM in a single-centre retrospective study targeting AAV patients, including 303 MPA patients, and reported that their RPM demonstrated superior performance compared to FFS and BVAS in predicting life prognosis [25]. In this study, we proposed a simple RPM to predict the prognosis of patients with MPA enrolled in a multicentre cohort of Japanese patients with vasculitis.…”