Total Tubulointerstitial Score: a simple and effective predictor of long-term mortality and adverse renal outcomes in lupus nephritis.

IF 3.5 2区医学 Q1 RHEUMATOLOGY

Lupus Science & Medicine Pub Date : 2025-06-20 DOI:10.1136/lupus-2025-001578

Xinxin Zhang, Manhuai Zhang, Xiaolei Shi, Wang Xiang, Yuewen Lu, Jiaqing Tan, Jianwen Yu, Hongjian Ye, Zhong Zhong, Jiang Lanping, Ruihan Tang, Xi Xia, Wei Chen

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引用次数: 0

Abstract

Objective: Most studies focused on glomerular lesions in lupus nephritis (LN). However, the predictive value for tubulointerstitial lesions remains less well understood and controversial. Here, we assessed the impact of tubulointerstitial lesions, quantified by Total Tubulointerstitial Lesions Score (TTS), on long-term renal outcomes and mortality in LN.

Methods: We conducted a cohort study of 832 patients with LN diagnosed from 1996 to 2018 at the First Affiliated Hospital of Sun Yat-sen University. Patients were stratified by the median of TTS (TTS ≤2 vs TTS >2 groups), which included the total score of tubulointerstitial inflammation, tubular atrophy and interstitial fibrosis by the 2018 ISN/RPS (International Society of Nephrology and Renal Pathology Society) classification semi-score. We used Kaplan-Meier survival curves and Cox regression models to analyse the associations between TTS and patient outcomes.

Results: Pearson's correlation analysis revealed that TTS was negatively correlated with estimated glomerular filtration rate, haemoglobin and serum albumin levels, while positively correlated with proteinuria levels. TTS was significantly higher in patients with proliferative LN. Kaplan-Meier analysis showed that patients with higher TTS had a higher risk of all-cause mortality and adverse renal outcomes. Multivariate Cox analysis identified TTS >2 (HR=1.50, 95% CI=1.02 to 2.22, p=0.039) and higher tubulointerstitial inflammation and tubular atrophy as the independent predictor of all-cause mortality, and TTS >2 (HR=1.63, 95% CI=1.05 to 2.52, p=0.030) and severer tubulointerstitial inflammation, tubular atrophy and interstitial fibrosis were independently associated with adverse renal outcomes.

Conclusions: TTS provides a comprehensive assessment of renal tubulointerstitial lesions and is a simple and effective predictor of long-term mortality and adverse renal outcomes in LN.

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总小管间质评分：一种简单有效的预测狼疮性肾炎长期死亡率和不良肾脏预后的指标。

目的：大多数研究集中在狼疮性肾炎（LN）的肾小球病变。然而，对小管间质病变的预测价值仍然不太清楚和有争议。在这里，我们评估了用总管间质病变评分（TTS）量化的管间质病变对LN患者长期肾脏预后和死亡率的影响。方法：我们对1996年至2018年中山大学第一附属医院诊断为LN的832例患者进行了队列研究。根据TTS的中位数（TTS≤2 vs TTS bbbb2组）对患者进行分层，其中包括2018年ISN/RPS（国际肾脏病与肾脏病理学会）分类半分的小管间质炎症、小管萎缩和间质纤维化的总分。我们使用Kaplan-Meier生存曲线和Cox回归模型来分析TTS与患者预后之间的关系。结果：Pearson相关分析显示，TTS与估算的肾小球滤过率、血红蛋白和血清白蛋白水平呈负相关，与蛋白尿水平呈正相关。增生性LN患者TTS显著增高。Kaplan-Meier分析显示，TTS较高的患者有较高的全因死亡率和不良肾脏结局风险。多因素Cox分析发现，TTS >2 （HR=1.50, 95% CI=1.02 ~ 2.22, p=0.039）和较高的小管间质炎症和小管萎缩是全因死亡率的独立预测因子，TTS >2 （HR=1.63, 95% CI=1.05 ~ 2.52, p=0.030）和较严重的小管间质炎症、小管萎缩和间质纤维化与肾脏不良结局独立相关。结论：TTS提供了肾小管间质病变的全面评估，是LN患者长期死亡率和不良肾脏结局的简单有效预测指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lupus Science & Medicine RHEUMATOLOGY-

CiteScore

5.30

自引率

7.70%

发文量

审稿时长

15 weeks

期刊介绍： Lupus Science & Medicine is a global, peer reviewed, open access online journal that provides a central point for publication of basic, clinical, translational, and epidemiological studies of all aspects of lupus and related diseases. It is the first lupus-specific open access journal in the world and was developed in response to the need for a barrier-free forum for publication of groundbreaking studies in lupus. The journal publishes research on lupus from fields including, but not limited to: rheumatology, dermatology, nephrology, immunology, pediatrics, cardiology, hepatology, pulmonology, obstetrics and gynecology, and psychiatry.