Establishment of a risk assessment model for predicting the prognosis of patients with anti-MDA5 antibody-positive dermatomyositis complicated with interstitial pneumonia based on inflammatory indicators

doi:10.3969/j.issn.1673-8640.2025.09.003

Abstract

Abstract:

Objective To establish a nomogram model based on inflammatory indicators to predict the risk of poor prognosis in patients with anti-melanoma differentiation-associated gene 5（MDA5）antibody-positive dermatomyositis complicated with interstitial pneumonia，and to evaluate its efficacy. Methods A total of 107 patients with anti-MDA5 antibody-positive dermatomyositis complicated with interstitial pneumonia in the First People's Hospital of Jiaxing from February 2022 to October 2023 were enrolled. These patients were classified into good prognosis group（76 cases）and poor prognosis group（31 cases）based on the prognosis after 6 months of treatment. The clinical data were collected，and erythrocyte sedimentation rate（ESR）and the levels of serum ferritin（FER），C-reactive protein（CRP），interleukin-6（IL-6），albumin，as well as neutrophil-to-lymphocyte ratio（NLR），monocyte-to-lymphocyte ratio（MLR），systemic immune-inflammation index（SII）and C-reactive protein-to-albumin ratio（CAR）were performed and determined. Spearman correlation analysis was used to evaluate the correlation between each indicator and the poor prognosis of patients with anti-MDA5 antibody-positive dermatomyositis complicated with interstitial pneumonia. Multivariate Logistic regression analysis was used to evaluate the influencing factors of poor prognosis in patients with anti-MDA5 antibody-positive dermatomyositis complicated with interstitial pneumonia. A nomogram model was established. The efficiency of nomogram model was evaluated by receiver operating characteristic（ROC）curve，decision curve，calibration curve and Hosmer-Lemeshow goodness-of-fit test. Results The ESR，NLR，SII，FER，CRP and CAR in poor prognosis group were higher than those in good prognosis group（P<0.001），while there was no statistical significance in MLR and IL-6 between the 2 groups（P>0.05）. Anti-MDA5 antibody +++，ESR，NLR，SII，FER，CRP and CAR were all positively correlated with the poor prognosis of patients with anti-MDA5 antibody-positive dermatomyositis complicated with interstitial pneumonia（P<0.05）. SII，FER and CAR were independent risk factors for poor prognosis in patients with anti-MDA5 antibody-positive dermatomyositis complicated with interstitial pneumonia（P<0.05）. Based on SII，FER and CAR，a nomogram model was established to predict the poor prognosis of patients with anti-MDA5 antibody-positive dermatomyositis complicated with interstitial pneumonia. The area under curve（AUC）of the nomogram model was 0.987. The fit of the nomogram model was high（Hosmer-Lemeshow χ²=1.983，p=0.982），and the clinical net benefit was >0 within the threshold probability range of 0 to 0.99，with the maximum net benefit value of 0.27. Conclusions The nomogram model established based on SII，FER and CAR has a high clinical efficacy in evaluating the prognosis of patients with anti-MDA5 antibody-positive dermatomyositis complicated with interstitial pneumonia.

Key words: Anti-melanoma differentiation-associated gene 5 antibody, Inflammatory indicator, Dermatomyositis, Interstitial pneumonia, Prognosis assessment

CLC Number:

R446.62

YUAN Xiwei, WANG Yiwen, FEI Zhangli, HUANG Wan. Establishment of a risk assessment model for predicting the prognosis of patients with anti-MDA5 antibody-positive dermatomyositis complicated with interstitial pneumonia based on inflammatory indicators[J]. Laboratory Medicine, 2025, 40(9): 841-847.

Figures/Tables 9

References 25

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组别	例数	年龄/岁	性别			抗MDA5抗体		肌力下降/[例（%）]
组别	例数	年龄/岁	男/[例（%）]	女/[例（%）]		+~++/[例（%）]	+++/[例（%）]	肌力下降/[例（%）]
预后不良组	31	56（44，66）	14（45.16）	17（54.84）		12（38.71）	19（61.29）	16（51.61）
预后良好组	76	57（42，65）	33（43.42）	43（56.58）		46（60.53）	30（39.47）	33（43.42）
统计值		0.196	0.027			4.222		0.595
P值		0.844	0.869			0.040		0.440
组别	雷诺现象/[例（%）]		皮疹/[例（%）]		关节疼痛/[例（%）]		发热/[例（%）]
预后不良组	2（6.45）		28（90.32）		18（58.06）		15（48.39）
预后良好组	3（3.95）		58（76.32）		34（44.74）		32（42.11）
统计值	0.310		2.739		1.566		0.353
P值	0.578		0.098		0.211		0.553

组别	例数	年龄/岁	性别			抗MDA5抗体		肌力下降/[例（%）]
组别	例数	年龄/岁	男/[例（%）]	女/[例（%）]		+~++/[例（%）]	+++/[例（%）]	肌力下降/[例（%）]
预后不良组	31	56（44，66）	14（45.16）	17（54.84）		12（38.71）	19（61.29）	16（51.61）
预后良好组	76	57（42，65）	33（43.42）	43（56.58）		46（60.53）	30（39.47）	33（43.42）
统计值		0.196	0.027			4.222		0.595
P值		0.844	0.869			0.040		0.440
组别	雷诺现象/[例（%）]		皮疹/[例（%）]		关节疼痛/[例（%）]		发热/[例（%）]
预后不良组	2（6.45）		28（90.32）		18（58.06）		15（48.39）
预后良好组	3（3.95）		58（76.32）		34（44.74）		32（42.11）
统计值	0.310		2.739		1.566		0.353
P值	0.578		0.098		0.211		0.553

项目	β值	标准误	Wald值	P值	OR^①值（95%CI^②）
NLR	0.874	1.169	0.559	0.455	2.396（0.242~3.696）
SII	0.015	0.007	5.606	0.018	1.016（1.003~1.029）
FER	0.022	0.008	6.824	0.009	1.022（1.005~1.039）
CRP	0.324	0.360	0.807	0.369	1.382（0.682~2.802）
CAR	7.631	1.059	6.243	0.012	2.053（1.039~2.991）

项目	β值	标准误	Wald值	P值	OR^①值（95%CI^②）
NLR	0.874	1.169	0.559	0.455	2.396（0.242~3.696）
SII	0.015	0.007	5.606	0.018	1.016（1.003~1.029）
FER	0.022	0.008	6.824	0.009	1.022（1.005~1.039）
CRP	0.324	0.360	0.807	0.369	1.382（0.682~2.802）
CAR	7.631	1.059	6.243	0.012	2.053（1.039~2.991）

项目	AUC（95%CI）	最佳临界值	敏感性/%	特异性/%	Youden指数
SII	0.871（0.787~0.955）	797.12	82.89	83.87	0.668
FER	0.890（0.812~0.969）	693.91 μg·L^-1	96.05	74.19	0.702
CAR	0.854（0.751~0.957）	0.27	97.37	74.19	0.716
列线图模型	0.987（0.968~0.998）		98.04	89.44	0.875