Bryan et al developed a simple score for predicting survival and the risk of mortality at 5 years after presentation in patients with scleroderma. This can help identify patients requiring more aggressive therapy and closer monitoring. The authors are from the University of Manchester and Royal Free Hospital (London) in England.
Parameters:
(1) urine protein
(2) erythrocyte sedimentation rate (ESR)
(3) carbon monoxide diffusing capacity
|
Parameter |
Finding |
Points |
|
urine protein |
absent or trace |
0 |
|
|
present (1+ or greater) |
1 |
|
ESR |
< 25 mm/h |
0 |
|
|
>= 25 mm/h |
1 |
|
carbon monoxide diffusing capacity |
>=70% |
0 |
|
|
< 70% |
1 |
where:
• The method for ESR measurement was not given.
• The method for determining protein in the urine was not stated. I assume that it was a urine dipstick. On page 2663 it states that positive urine protein was greater than trace.
total score =
= SUM(points for all 3 measurements)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score, the higher the mortality rate at 5 years.
|
Total Score |
Mortality Rate |
Survival Rate |
|
0 |
7% |
93% |
|
1 |
23% |
77% |
|
2 |
55% |
45% |
|
3 |
100% |
0% |
after Table 5, page 2663
Performance:
• The overall accuracy of prediction was 82% (positive predictive value 70% and negative predictive value 86%).
• In a Monte Carlo model the overall accuracy was 70% (positive predictive value 69% and negative predictive value 82%).
Purpose: To predict survival in a patient presenting with scleroderma using the simple risk model of Bryan et al.
Specialty: Immunology/Rheumatology
Objective: risk factors, severity, prognosis, stage, disease progression, end-of-life, palliative care
ICD-10: M34,
