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- Title
Development and Validation of a Nomogram for Predicting Generalization in Patients With Ocular Myasthenia Gravis.
- Authors
Zhe Ruan; Chao Sun; Yanlin Lang; Feng Gao; Rongjing Guo; Quan Xu; Liping Yu; Songdi Wu; Tao Lei; Yu Liu; Min Zhang; Huanhuan Li; Yonglan Tang; Ting Gao; Yanwu Gao; Xiaodan Lu; Zhuyi Li; Ting Chang
- Abstract
Background: This study aims to develop and validate a nomogram for predicting 1- and 2-year generalization probabilities in patients with ocular myasthenia gravis (OMG). Methods: In total, 501 eligible patients with OMG treated at seven tertiary hospitals in China between January 2015 and May 2019 were included. The primary outcome measure was disease generalization. A nomogram for predicting 1- and 2-year generalization probabilities was constructed using a stepwise Cox regression model. Nomogram performance was quantified using C-indexes and calibration curves. Twoyear cumulative generalization rates were analyzed using the Kaplan-Meier method for distinct nomogram-stratified risk groups. The clinical usefulness of the nomogram was evaluated using decision curve analysis (DCA). Result: The eligible patients were randomly divided into a development cohort (n=351, 70%) and a validation cohort (n=150, 30%). The final model included five variables: sex, onset age, repetitive nerve stimulation findings, acetylcholine receptor antibody test results, and thymic status. The model demonstrated good discrimination (C-indexes of 0.733 and 0.788 in the development and validation cohorts, respectively) and calibration, with good agreement between actual and nomogram-estimated generalization probabilities. Kaplan -Meier curves revealed higher 2-year cumulative generalization rates in the high-risk group than that in the low-risk group. DCA demonstrated a higher net benefit of nomogramassisted decisions compared to treatment of all patients or none. Conclusion: The nomogram model can predict 1- and 2-year generalization probabilities in patients with OMG and stratified these patients into distinct generalization risk groups. The nomogram has potential to aid neurologists in selecting suitable patients for initiating immunotherapy and for enrolment in clinical trials of risk-modifying treatments.
- Subjects
CHINA; MYASTHENIA gravis; NOMOGRAPHY (Mathematics); GENERALIZATION; DECISION making; NEURAL stimulation
- Publication
Frontiers in Immunology, 2022, Vol 13, p1
- ISSN
1664-3224
- Publication type
Article
- DOI
10.3389/fimmu.2022.895007