Fernandez-Ruiz et al reported the SIMPLICITY score to predict the risk of infection following a renal transplant. This can help to identify a patient who may require more aggressive management. The authors are from multiple institutions in Spain participating in the Spanish Network for Research in Infectious Diseases and Spanish Network for Research in Renal Diseases.
SIMPLICITY is derived from Seeking for IMmune status on Peripheral blood Lymphocytes, Igs and Complement activITY.
Patient selection: renal transplant recipient
Sample collection: 1 month after transplantation
Parameters:
(1) recipient age in years
(2) eGFR in mL per minute
(3) infection within the first month
(4) CD4-positive T-cell count per microliter
(5) CD8-positive T-cell count per microliter
(6) serum IgG concentration in mg/dL
(7) serum C3 concentration in mg/dL
|
Parameter
|
Finding
|
Points
|
|
recipient's age
|
< 62 years
|
0
|
|
|
>= 62 years
|
3
|
|
eGFR
|
>= 37 mL/min
|
0
|
|
|
< 37 mL/min
|
3
|
|
infection
|
no
|
0
|
|
|
yes
|
3
|
|
CD4-positive T cells
|
>= 40 per µL
|
0
|
|
|
< 40 per µL
|
3
|
|
CD8-positive T cells
|
>= 155 per µL
|
0
|
|
|
< 155 per µL
|
2
|
|
serum IgG
|
>= 500 mg/dL
|
0
|
|
|
< 500 mg/dL
|
3
|
|
serum C3
|
>= 78 mg/dL
|
0
|
|
|
< 78 mg/dL
|
4
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 21
|
Score
|
Risk Group
|
6-Month Cumulative Infection (Figure 3)
|
|
0 to 3
|
low
|
8-14%
|
|
4 to 9
|
intermediate
|
23-35%
|
|
10 to 21
|
high
|
60-80%
|
Performance:
• The area under the ROC curve is 0.77
