Tao Wang1, Yan Zhang2, Fen Ping3, Huizhi Zhao4, Li Yan5, Qiongzhen Lin6, Hui Zhang7. 1. Department of Nephrology, HeBei General Hospital, ShiJiaZhuang, China. 2. Department of Dermatology, the 4th Affiliated Hospital of HeBei Medical University, ShiJiaZhuang, China. 3. The 2nd Department of Respiratory Diseases, HeBei General Hospital, ShiJiaZhuang, China. 4. Office of Medical Records and Statistics, HeBei General Hospital, ShiJiaZhuang, China. 5. The 1st Department of Respiratory Diseases, HeBei General Hospital, ShiJiaZhuang, China. 6. Department of Nephrology, Provincial Research Institute of Kidney Diseases, ShiJiaZhuang, China. 7. MRI Division, Department of Radiology, HeBei General Hospital, ShiJiaZhuang, China.
Abstract
AIM: Pulmonary infection (PI) is the leading cause of death in patients with primary membranous nephropathy on immunosuppressive therapy. A rating score was thus developed to foresee the risk of PI in such patients. METHODS: We reviewed the charts of the pertinent patients treated during the past 3 years either with (n = 29) or without PI (n = 304). Clinical and laboratory data, the usage of cyclosporin A (CysA), and occurrence of PI were recorded. Cox regression analysis and receiver operating characteristic (ROC) curve were respectively used to identify the risk factors and assess their clinical relevance. RESULTS: The incidence of PI was 8.7% at 82.1 ± 20.9 days after the initiation of CysA regimen with a male predominance superimposed on smoking. Factors associated with PI were immunoglobulin G titer (hazard ratio = 4.56, 95% confidence interval = 2.31-8.95), plasma CysA concentration (3.71, 1.87-6.18), serum creatinine level (2.57, 1.31-5.82), CD4+ /CD8+ ratio (2.36, 1.26-6.06) and plasma albumin content (1.53, 1.05-3.25). These five factors, along with the male gender and smoking status, were granted different ratings after examined by the ROC curve and constituted the anticipating pulmonary infection in primary membranous nephropathy receiving CysA (AIM-7C) score. Accordingly, the respective percent composition of the infection and non-infection group was 0, 11.1%, 72.2%, 16.7% and 91.7%, 8.3%, 0, 0 in the order of low, moderate, high and utmost risk. Furthermore, eight new cases of PI were successfully predicted. CONCLUSION: Our AIM-7C score may therefore help to predict the onset and facilitate the prevention of PI, a potentially life-threatening complication of the immunosuppressive therapy.
AIM: Pulmonary infection (PI) is the leading cause of death in patients with primary membranous nephropathy on immunosuppressive therapy. A rating score was thus developed to foresee the risk of PI in such patients. METHODS: We reviewed the charts of the pertinent patients treated during the past 3 years either with (n = 29) or without PI (n = 304). Clinical and laboratory data, the usage of cyclosporin A (CysA), and occurrence of PI were recorded. Cox regression analysis and receiver operating characteristic (ROC) curve were respectively used to identify the risk factors and assess their clinical relevance. RESULTS: The incidence of PI was 8.7% at 82.1 ± 20.9 days after the initiation of CysA regimen with a male predominance superimposed on smoking. Factors associated with PI were immunoglobulin G titer (hazard ratio = 4.56, 95% confidence interval = 2.31-8.95), plasma CysA concentration (3.71, 1.87-6.18), serum creatinine level (2.57, 1.31-5.82), CD4+ /CD8+ ratio (2.36, 1.26-6.06) and plasma albumin content (1.53, 1.05-3.25). These five factors, along with the male gender and smoking status, were granted different ratings after examined by the ROC curve and constituted the anticipating pulmonary infection in primary membranous nephropathy receiving CysA (AIM-7C) score. Accordingly, the respective percent composition of the infection and non-infection group was 0, 11.1%, 72.2%, 16.7% and 91.7%, 8.3%, 0, 0 in the order of low, moderate, high and utmost risk. Furthermore, eight new cases of PI were successfully predicted. CONCLUSION: Our AIM-7C score may therefore help to predict the onset and facilitate the prevention of PI, a potentially life-threatening complication of the immunosuppressive therapy.