PhD Scientific Days 2023

Budapest, 22-23 June 2023

Clinical Medicine - Posters J

Proposal of novel risk prediction score for major adverse cardiovascular events in lupus nephritis

Adél Molnár1, Márk Juha1, Klaudia Bulajcsík2, Deján Dobi3, András Tislér1, Nóra Ledó1
1 Department of Internal Medicine and Oncology, Budapest
2 Semmelweis University, Budapest
3 Department of Pathology, Forensic and Insurance Medicine

Text of the abstract

Introduction: Patients with systemic lupus erythematosus are at greater risk to develop cardiovascular diseases (CVD), which contribute to morbidity and mortality.
Aims: Our objective was to identify factors that could aid the prediction of CVD risk and major adverse cardiovascular events (MACE) in this population. We sought to develop a model that could be applied to estimate the long-term CVD risk in lupus nephritis (LN) patients.
Methods: We conducted a retrospective analysis on LN patients. Demographic variables, cardiovascular events, clinical and histological data were collected from patients who underwent kidney biopsy between 2005 and 2020 in the Department of Internal Medicine and Oncology. Chi-square, Mann-Whitney U-test, and logistic regression analyses were performed (IBM SPSS Statistics v28). Receiver Operating Characteristic (ROC) curve was used to determine optimal cut-off values. (Approval by the Ethics Committee: SE RKEB 225/2018.)
Results: 91 patients were enrolled in this period. The mean age was 37.3±12.3 years, 86% females, the mean follow-up time was 62±48 months. 15.38% of patients underwent at least one MACE event. Two patients were deceased of CVD. Increased age (35.81±11.14 vs 45.5±15.11, p=0.012) entailed a higher occurrence of MACE events. Complete white blood cell (3.54±0.41 vs 3.25±0.87, p=0.026) and neutrophil count (2.85±0.33 vs 3.11±0.83, p=0.001) were higher, whereas diastolic blood pressure (DBP) was lower (89.51±10.96 vs 78.43±6.9, p<0.001) at the time of the biopsy in patients with MACE complication. Age, neutrophil count, and DBP were demonstrated to be independent predictors of MACE events. Based on these results, we proposed a new model (CANDE - Cardiovascular risk – based on Age, Neutrophil count, and Diastolic blood pressure - Estimation score) that is a stronger predictor of future MACE at the time of the biopsy in LN patients. The greater the score was, the more frequently MACE cases occurred. ROC curve analysis revealed that at a 0.78 cut-off value, the score predicts MACE occurrence with a sensitivity of 0.75 and a specificity of 0.61.
Conclusions: Age, neutrophil count, and DBP have been shown to be independent risk factors for MACE in lupus nephritis. The score derived from these parameters (CANDE) is a more reliable predictor of MACE events at the time of the biopsy.
Funding: NKFIH – KLINO_FK_142911