CS-12 Outcomes of lupus nephritis in vulnerable populations
Bibliographic record
Abstract
Background Lupus nephritis is a known predictor of mortality; we examined the risks of end-stage renal disease (ESRD) and death among lupus nephritis patients, and included the impact of ethnicity, low income (LowInc), lack of education (LowEduc), and living >500 km from rheumatology care (Remote). Methods Patients from a single academic center were followed from 1990–2016 using a custom database. Records of all SLE patients were abstracted. Variables included birthdate, diagnosis date, ethnicity, ACR classification criteria (ACRc), SLICC Damage Index (SDI) including ESRD, treatment and date of death. Ethnicity was categorized into North American Indigenous (IND), Asian (ASN), Caucasian (CAU), and Other. In patients who had developed nephritis, Kaplan Meier and Cox proportional hazard models were used to compare ESRD and survival between vulnerable groups. Results Nine hundred forty-four SLE patients were identified: 240 (25%) IND, 576(60%) CAU, 104(11%) ASN and 24(2.5%) Other. ‘Other’ patients were excluded from further analysis. Mean disease duration was 14 years, 89% female. Nephritis developed in 39% of CAU (n=224), 57% of IND (n=136; OR 2.1; 95% CI 1.5 to 2.8), and 75% of ASN (n=76; OR 4.7; 95% CI 2.9 to 7.6), p<0.001. Twenty percent of patients had not completed high school, 20% were LowInc, and 11% were Remote; LowInc, LowEduc, and Remote did not increase the odds of nephritis. Among nephritis patients, ESRD developed in 11% and 17% died. Risk of ESRD was increased in IND (HR 4.2; 95% CI 2.0 to 8.6) and ASN (HR 5.8; 95% CI 2.6 to 12.6) compared to CAU (figure 1a). Risk of death was increased in IND (HR 2.6; 95% CI 1.6 to 4.2), but not in ASN (HR 1.1; 95% CI 0.5 to 2.4) compared to CAU (figure 1b). In separate cox proportional hazards models, after adjustment for age, gender, SDI, ACRc, and age at diagnosis, risk of ESRD was increased in NAI (HR 2.8; 95% CI 1.0 to 8.1) and ASN (HR 4.0; 95% CI 1.6 to 10.3) compared to CAU. LowInc, LowEduc, and Remote did not increase risk of ESRD. Only LowEduc (HR 2.1; 95% CI 1.1 to 3.9) increased the adjusted risk of death; ethnicity, LowInc and Remote were not significant. Conclusions Compared to CAU, IND and ASN not only have a higher risk of nephritis, but among those with nephritis, risk of ESRD is 3–4 fold higher in IND and ASN. Lack of education, rather than ethnicity, was the major risk factor for death. Reasons for these differences may include renal pathology, care pathways, comorbid conditions and additional socioeconomic factors and need to be further explored. Acknowledgements We gratefully acknowledge the Lupus Society of Manitoba for ongoing funding for this work.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".