背景:指甲受累对银屑病患者有巨大影响。早期发现和及时干预牛皮癣指甲损伤是必要的。
方法:从银屑病数据库的随访研究中招募了2020年6月至2021年9月期间确认患有银屑病的4290例患者。其中,选择3920例患者,根据纳入和排除标准分为指甲受累组(n=929)和非指甲受累组(n=2991)。进行了单变量和多变量逻辑回归分析,以确定列线图中指甲受累的预测因素。校准图,接收器工作特性(ROC)曲线,和决策曲线分析(DCA)用于评估列线图的辨别和校准能力以及临床实用性。
结果:性别,发病年龄,持续时间,吸烟,药物过敏史,合并症,银屑病的亚型,头皮受累,掌plant受累,生殖器受累,选择PASI评分来建立指甲受累的列线图。AUROC(0.745;95%CI:0.725-0.765)表明列线图具有令人满意的辨别能力。校准曲线显示出良好的一致性,DCA显示了列线图的良好临床实用性。
结论:开发了具有良好临床实用性的预测列线图,以帮助临床医生评估牛皮癣患者的指甲受累风险。
BACKGROUND: Nail involvement has a tremendous impact on psoriasis patients. Early detection and prompt intervention of psoriatic nail damage are necessary.
METHODS: A total of 4290 patients confirmed to have psoriasis between June 2020 and September 2021 were recruited from the Follow-up Study of Psoriasis database. Among them, 3920 patients were selected and divided into the nail involvement group (n = 929) and the non-nail involvement group (n = 2991) by inclusion and exclusion criteria. Univariate and multivariable logistic regression analyses were performed to identify the predictors of nail involvement for the nomogram. Calibration plots, the receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to evaluate the discriminative and calibrating ability and clinical utility of the nomogram.
RESULTS: Sex, age at onset, duration, smoking, drug allergy history, comorbidity, sub-type of psoriasis, scalp involvement, palmoplantar involvement, genital involvement, and PASI score were selected to establish the nomogram for nail involvement. AUROC (0.745; 95% CI: 0.725-0.765) indicated the satisfactory discriminative ability of the nomogram. The calibration curve showed favorable consistency, and the DCA showed the good clinical utility of the nomogram.
CONCLUSIONS: A predictive nomogram with good clinical utility was developed to assist clinicians in evaluating the risk of nail involvement in psoriasis patients.