Does decision tree analysis predict oral ulcer activity-related factors in patients with Behçet's syndrome?

BACKGROUND: Immunoglobulin A nephropathy (IgAN) patients with acute kidney injury (AKI) have an elevated risk of adverse events and mortality. However, there is currently a lack of convenient and effective clinical tools to predict AKI risk in this population. The present study was conducted to create such tools containing inflammatory and nutritional indexes.

METHOD: Data from 720 adults diagnosed with IgAN by renal biopsy at the First Hospital of Jilin University were collected. They were randomly divided into a training set (n = 503) and a test set (n = 217) in a 7:3 ratio. Univariate and multivariate logistic regression analyses with backward selection were used to identify risk factors, resulting in multiple prediction models. The least absolute shrinkage and selection operator (LASSO) regression was used to simplify the model. The models were presented using nomograms, and their performances were evaluated through receiver operating characteristic (ROC) curves, area under the curve (AUC), Hosmer-Lemeshow test, net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration curves, and clinical decision curve analysis (DCA).

RESULTS: Eleven risk factors related to IgAN with AKI were identified, including nephrotic syndrome (NS), T score from the Oxford histological classification, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), 24-hour urinary protein quantification (24h-UPRO), C-reactive protein (CRP), systemic inflammatory response index (SIRI), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-CRP ratio (LCR), and prognostic nutritional index (PNI). These factors contributed to the development of seven prediction models. ROC curves indicated good predictive performance for all models, with the full model performing best. The Hosmer-Lemeshow test showed that six models fit well in the test set. DCA results demonstrated significant clinical benefits for all models.

CONCLUSION: CRP, SIRI, LMR, PLR, LCR, and PNI were identified as novel AKI predictors in patients with IgAN. A series of prediction models incorporating these factors were developed for better clinical applicability, with the full model performing the best.