Neutrophil-to-platelet ratio predicts adverse renal outcomes in anti-neutrophil cytoplasmic antibody-associated vasculitis and its synergistic multifactor optimization model
Objective To explore the relationship between neutrophil-to-platelet ratio(NPR)and the first-year renal prognosis in patients with renal damage caused by anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV),so as to find the cut-off value of NPR for assessing first-year renal prognosis,and to construct a high-perform-ance prognostic prediction model.Methods Clinical data of 258 patients with renal damage caused by AAV who were admitted to Qilu Hospital of Shandong University during Jan.2010 and Nov.2021 were retrospectively analyzed.The re-lationship between NPR and laboratory indicators at diagnosis as well as the first-year renal replacement therapy(RRT)rate was analyzed.Receiver operating characteristic curve was plotted to calculate the cut-off value of NPR.After that,patients were classified into high NPR group(n= 41)and low NPR group(n= 82).Mann-Whitney U test and chi-square test were used to analyze the differences between the two groups.The relationship between NPR and first-year RRT rate was analyzed by constructing a binary Logistic regression model.The first-year renal prognosis prediction model was established with NPR and other factors.Results There were 22 male(53.7%)and 19 female(46.3%)in the high NPR group,and 46 male(56.1%)and 36 female(43.9%)in the low NPR group.Altogether 24 patients(19.5%)underwent RRT within the first year.Univariate and multivariate binary Logistic regression analysis were per-formed,and significant variables in univariate analysis were included in multivariate analysis.High level of Birmingham vasculitis activity score(BVAS)(OR = 1.272,95%CI:1.034-1.567,P = 0.023),high level of serum creatinine(SCR)(OR=1.008,95%CI:1.004-1.012,P<0.001),and high level of NPR(OR=4.931,95%CI:1.153-21.091,P=0.031)were predictors of RRT within the first year.NPR>0.0332 was an independent predictor of RRT.The binary Logistic regression model of NPR combined with multifactor functioned well in predicting the first-year RRT rate,with an area under the curve(AUC)of 0.960(95%CI:0.889-0.997,P<0.001).Conclusion NPR is a convenient and cost-effective inflammation indicator.Patients with NPR>0.033 2 are more likely to enter end-stage renal disease(ESRD)and undergo RRT within the first year after initial diagnosis.The first-year renal prognostic prediction model constructed in this study,including BVAS,hemoglobin,albumin,SCR and NPR,has a good predictive performance.
Anti-neutrophil cytoplasmic antibodyVasculitisNeutrophil-to-platelet ratioRenal prognosisConstruc-tion of predictive model
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