目 的
將並發症按其對類風濕性關節炎(RA)影響的重要性進行分級。根據可能對患者住院和死亡風險產生影響的並發症計算並驗證未來適用的並發症指數，對RA患者進行分級。
方 法
研究根據2029名病史超過10年的RA患者的臨床病例，考慮並發症的數量和影響，設計出加權指數。研究運用邏輯和Cox回歸分析來估算出死亡風險。回歸係數被用來計算指數分數。指數的ROC曲線被用來評估指數的識別能力並計算處於不同死亡風險患者的不同邊界值，疾病活動度參數也在研究考慮範疇內。
結 果
與10年死亡風險關聯緊密的並發症(18種)用來生成RA-並發症指數，這些並發症包括心血管病(7種)、感染、骨質疏鬆性骨折、摔倒風險、抑鬱/焦慮、糖尿病、機能狀態(HAQ >2)、類固醇治療>5 mg、DAS-28 >3.2、腎/肝/肺部疾病和腫瘤。研究考慮並發症數量，運用並發症校正後的相對風險作為權數設計出加權指數。運用ROC曲線證實AUC(曲線下麵積)為97%。
結 論
RA-並發症指數能有效評估RA患者的死亡風險。該指數使醫生在常規操作中將並發症評估和並發症治療納入考慮範疇，並通過找出潛在高風險RA患者來降低高昂成本。
原 文
Rheumatoid Arthritis Comorbidity Index (RACI): Development and Validation of a New Comorbidity Index for Rheumatoid Arthritis Patients
El Miedany Y1,2*, El Gaafary M3, Youssef S2, Samah Almedany4, Sami Bahlas5 and Hegazi M61Rheumatology, Darent Valley Hospital, Dartford, United Kingdom2Rheumatology & Rehab, Ain Shams University, Cairo, Egypt3Community and Public Health, Ain Shams University, Cairo, Egypt4Rheumatology and Rehabilitation, Tanta University, Egypt5Rheumatology, King Abdulaziz University, Jeddah, Saudi Arabia6Medicine, Al Adan Hospital, Kuwait
Corresponding Author:El Miedany YDarent Valley HospitalDartford, Kent, DA2 8DA, England
DOI: 10.4172/2167-7921.1000244redited.
Objective
Classify comorbidities with greatest impact on Rheumatoid Arthritis (RA) patients. Develop and validate a prospectively applicable comorbidity index for classifying RA patients according to their comorbid disorders which might impact alter their hospitalization and mortality risk.
Methods
A weighted index which considers the number and impact of comorbid conditions was developed based on clinical registry of a cohort of 2029 patients with early RA monitored over 10-years. Logistic and Cox Regression analyses were implemented to estimate the risk of mortality. Regression coefficients were used to develop the index score. ROC curve for the invented index was used to evaluate the discriminating ability of the index and identify different cutoff values that can delineate patients at different stages for risk of death. Disease activity parameters were considered.
Results
Comorbidities (18 conditions) were strongly associated with the 10-year death risk, and composed the RA-comorbidity index, include Cardiovascular (7 comorbidities), infection, osteoporotic fractures, falls risk, Depression/anxiety, functional status (HAQ >2), diabetes mellitus, steroid therapy >5 mg, DAS-28 >3.2, renal/liver/ lung disease and tumors. Considering the comorbidities number, the comorbidities adjusted relative risk were employed as weights to develop a weighted index. Validation using ROC curve revealed AUC of 97%.
Conclusion
The RA-comorbidity index is a valid method for assessing risk of death in RA patients. The index enables the treating physician to include comorbidities valuation and treatment in their standard practice. It can be used to identify targets, predict resource utilization, and detect the potential targets for lowering high costs, by prospectively recognizing RA patients at high risk.
