目 的

        将并发症按其对类风湿性关节炎(RA)影响的重要性进行分级。根据可能对患者住院和死亡风险产生影响的并发症计算并验证未来适用的并发症指数，对RA患者进行分级。

方 法

        研究根据2029名病史超过10年的RA患者的临床病例，考虑并发症的数量和影响，设计出加权指数。研究运用逻辑和Cox回归分析来估算出死亡风险。回归系数被用来计算指数分数。指数的ROC曲线被用来评估指数的识别能力并计算处于不同死亡风险患者的不同边界值，疾病活动度参数也在研究考虑范畴内。

结 果

        与10年死亡风险关联紧密的并发症(18种)用来生成RA-并发症指数，这些并发症包括心血管病(7种)、感染、骨质疏松性骨折、摔倒风险、抑郁/焦虑、188bet在线平台网址 、机能状态(HAQ >2)、类固醇治疗>5 mg、DAS-28 >3.2、肾/肝/肺部疾病和肿瘤。研究考虑并发症数量，运用并发症校正后的相对风险作为权数设计出加权指数。运用ROC曲线证实AUC(曲线下面积)为97%。

结 论

        RA-并发症指数能有效评估RA患者的死亡风险。该指数使医生在常规操作中将并发症评估和并发症治疗纳入考虑范畴，并通过找出潜在高风险RA患者来降低高昂成本。

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.