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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (6): 1017-1022. doi: 10.19723/j.issn.1671-167X.2024.06.011

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Analysis of characteristics related to the disease activity of systemic lupus erythematosus and construction of an evaluation model

Hongyan WANG1, Xinming LI2,3, Kechi FANG2,3, Huaqun ZHU1, Rulin JIA1,*(), Jing WANG2,3,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
    2. Institute of Psychology, Chinese Academy of Sciences; Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing 100101, China
    3. Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
  • Received:2024-08-01 Online:2024-12-18 Published:2024-12-18
  • Contact: Rulin JIA, Jing WANG E-mail:1036013457@qq.com;wangjing@psych.ac.cn
  • Supported by:
    the National Natural Science Foundation of China(31970648)

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Abstract:

Objective: To stratify systemic lupus erythematosus (SLE) patients clinically, to analyze the clinical characteristics of patients with and without disease activity, and to explore the application va-lue of key clinical indicators in assessing disease activity, as well as to construct an evaluation model. Methods: A retrospective analysis was conducted on clinical data of the SLE patients diagnosed at Peking University People' s Hospital from May 1995 to April 2014. Demographic information, clinical manifestations, laboratory tests, and antibody detection results were collected. The patients were divided into active and inactive groups based on systemic lupus erythematosus disease activity index 2000(SLEDAI-2000)scores. t-tests, Mann-Whitney U tests, and χ2 tests were used to compare the differences between the groups. Spearman correlation analysis was used to evaluate the relevant clinical indicators associated with SLE activity in the active disease group. Based on the results of statistical analysis, a Logistic regression model was constructed, and the performance of the model was evaluated. Results: No significant differences were found in demographic characteristics between the two groups. In the active disease group, positive rates of antinuclear antibodies (ANA) and anti-double-stranded DNA antibodies (anti-dsDNA) were increased; white blood cell count (WBC), red blood cell count (RBC), hemoglobin (HGB), lymphocytes (LY), total protein (TP), albumin (ALB), and complement 3(C3) levels were significantly decreased; while immunoglobulin A and G levels were markedly elevated. The correlation analysis results showed that hemoglobin, albumin, C3, and complement 4(C4) had higher correlation indices compared with other clinical indicators. Among these, C3 exhibited a certain negative correlation with disease activity. The Logistic regression model based on 12 significantly different indicators (P < 0.05) achieved an accuracy of 91.4%, sensitivity of 94.4%, specificity of 81.0%, and the area under curve (AUC) of the receiver operating characteristic (ROC) was 0.944. Conclusion: This study comprehensively evaluated a range of clinical indicators related to SLE disease activity, providing a thorough understanding of both laboratory and clinical markers. The Logistic regression model, which was primarily constructed using laboratory test indicators, such as inflammatory markers, immune response parameters, and organ involvement metrics, demonstrated a high degree of accuracy in assessing the disease activity in SLE patients. Consequently, this model might provide a new basis for the diagnosis and treatment of SLE patients, offering significant clinical diagnostic value.

Key words: Systemic lupus erythematosus, Clinical stratification, Disease activity, Clinical indicators

CLC Number: 

  • R593.2

Table 1

Comparison of clinical data items between active disease group and inactive disease group"

Items No activity (n=71) Active (n=238) χ2/U/t P
Gender, n (%) 8 658.00 0.550
    Female 65 (91.55) 212 (89.08)
    Male 6 (8.45) 26 (10.92)
Onset age/years, M (P25, P75) 26 (21, 35) 28 (21, 38) 8 938.50 0.459
Family history, n (%) 3 (4.23) 21 (8.82) 8 837.50 0.205
Clinical manifestations, n (%) 60 (84.51) 227 (95.38) 10 331.50 0.004
Creatinine/(μmoI/L), M (P25, P75) 58.0 (45.5, 78.5) 57.0 (46.0, 74.0) 8 392.50 0.932
WBC/(×109/L), M (P25, P75) 7.10 (5.18, 10.35) 5.08 (3.36, 7.35) 5 282.00 < 0.001
RBC/(×1012/L), M (P25, P75) 3.68 (3.42, 4.11) 3.53 (2.98, 4.04) 6 981.00 0.017
Hemoglobin/(g/L), M (P25, P75) 113.7 (105.2, 127.0) 105.5 (90.1, 121.0) 6 321.50 < 0.001
Hematocrit/%, M ( P25, P75 ) 32.10 (0.39, 36.75) 27.80 (5.65, 34.48) 7 364.50 0.097
PLT/(×109/L), ${\bar x}$ ±s 160.83 ± 82.57 165.77 ± 94.02 0.40 0.688
Lymphocytes/(×109/L), M (P25, P75) 1.40 (1.00, 2.04) 1.00 (0.67, 1.40) 5 951.50 < 0.001
TP/(g/L), ${\bar x}$ ±s 67.62 ± 9.80 64.09 ± 13.12 -2.09 0.038
Albumin/(g/L), ${\bar x}$ ±s 39.29 ± 5.74 33.74 ± 6.87 -6.16 < 0.001
ANA, n (%) 46 (68.66) 194 (85.46) 10.96 0.001
Anti-dsDNA, n (%) 18 (27.27) 119 (55.35) 12.25 < 0.001
Anti-Ro/SS-A, n (%) 19 (12.86) 82 (36.60) 1.99 0.158
Anti-La/SS-B, n (%) 7 (10.00) 19 (8.56) 0.05 0.832
Anti-U1RNP, n (%) 17 (24.29) 66 (31.27) 0.15 0.703
Anti-Sm, n (%) 9 (12.86) 34 (15.38) 0.03 0.870
IgA/(g/L), M ( P25, P75) 2.35 (1.71, 2.91) 2.81 (2.07, 3.87) 8 598.50 0.004
IgG/(g/L), M (P25, P75) 12.7 (10.12, 17.7) 16 (10.93, 22.08) 10 302.00 0.014
IgM/(g/L), M (P25, P75 ) 0.98 (0.64, 1.57) 1.14 (0.71, 1.54) 10 071.00 0.258
C3/(g/L), M (P25, P75) 0.86 (0.61, 1.00) 0.51 (0.36, 0.75) 9 139.00 < 0.001
C4/(g/L), M (P25, P75) 0.16 (0.11, 0.21) 0.11 (0.06, 0.16) 7 017.00 0.345

Figure 1

Correlation analysis of laboratory test indicators with SLEDAI-2000 scores in patients from the active disease group SLEDAI-2000, systemic lupus erythematosus disease activity index 2000; dsDNA, anti-double-stranded DNA antibodies; CM, clinical manifestations; ANA, antinuclear antibody; CR, creatinine; IgA, immunoglobulin A; IgM, immunoglobulin M; U1RNP, anti-U1 ribonucleoprotein antibodies; Ro/SS-A, anti-Ro/SS-A antibodies; IgG, immunoglobulin G; Sm, anti-Smith antibodies; La/SS-B, anti-La/SS-B antibodies; HCT, hematocrit; WBC, white blood cell; PLT, platelet; RBC, red blood cell; TP, total protein; LY, lymphocytes; HGB, hemoglobin; ALB, albumin C4, complement 4; C3, complement 3."

Table 2

Analysis results for the correlation between laboratory test indicators and SLEDAI-2000 scores in patients from the active disease group"

Items r P
Anti-dsDNA 0.175 0.007
Clinical manifestations 0.174 0.008
ANA 0.106 0.104
Creatinine 0.010 0.127
IgA 0.061 0.356
IgM 0.057 0.381
Anti-U1RNP 0.011 0.869
Anti-Ro/SS-A 0.006 0.926
IgG 0.003 0.969
Anti-Sm -0.002 0.979
Anti-La/SS-B -0.052 0.432
Hematocrit -0.159 0.015
WBC -0.170 0.009
PLT -0.213 0.001
RBC -0.255 < 0.001
TP -0.259 < 0.001
Lymphocytes -0.279 < 0.001
Hemoglobin -0.313 < 0.001
Albumin -0.361 < 0.001
C4 -0.375 < 0.001
C3 -0.435 < 0.001

Figure 2

ROC curve of the Logistic regression model ROC, receiver operating characteristic; AUC, area under curve."

Table 3

Weight coefficients of each indicator in the Logistic regression model"

Items w
Clinical manifestations -0.238
WBC 0.141
RBC -0.197
Hemoglobin 0.118
Lymphocytes 0.024
TP -0.275
Albumin 0.543
ANA-1 -0.134
ANA-2 0.000
ANA-3 0.108
ANA-4 0.253
ANA-5 -0.003
ANA-6 -0.009
ANA-7 -0.362
ANA-8 -0.105
ANA-9 -0.078
ANA-10 0.000
ANA-11 0.329
Anti-dsDNA-1 0.180
Anti-dsDNA-2 -0.180
IgA -0.033
IgG 0.040
C3 0.256
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