Predicting the Risk of Nail Involvement in Psoriasis Patients: Development and Assessment of a Predictive Nomogram
Abstract
:1. Introduction
2. Methods
2.1. Study Population
2.2. Ascertainment and Assessment
2.3. Statistical Analysis
3. Results
3.1. Demographic and Clinical Features of NI Group and Non-NI Group
3.2. Demographic and Clinical Characteristics with DLQI and PASI Score in NI Group
3.3. Construction of Nail Involvement Psoriasis (NIP) Prediction Model
3.4. Validation of Nail Involvement Psoriasis Risk Nomogram and Its Clinical Application
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations and Acronyms
Area Under the Receiver Operating Characteristic | AUROC |
Body Mass Index | BMI |
Body Surface Area | BSA |
Classification Criteria for Psoriatic Arthritis | CASPAR |
Concordance index | C-index |
Decision Curve Analysis | DCA |
Dermatology Life Quality Index | DLQI |
Psoriatic Arthritis | PsA |
Health-related Quality of Life | QoL |
International Classification of Diseases | ICD |
Interquartile Range | IQR |
Nail Involvement | NI |
Non-nail Involvement | non-NI |
Nail Involvement Psoriasis | NIP |
Nijmegene-Nail Psoriasis Activity Index tool | N-NAIL |
Nail Psoriasis Quality of life 10 | NPQ10 |
Nail Psoriasis Severity Index | NAPSI |
Psoriasis Area and Severity Index | PASI |
Psoriasis epidemiology screening tool | PEST |
Receiver Operating Characteristic | ROC |
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Demographic Characteristics | Total (n = 3920) | Nail Involvement (n = 929) | Non-Nail Involvement (n = 2991) | p Value |
---|---|---|---|---|
Sex, n (%) Female Male | 1382(35.26) 2538(64.74) | 246(26.48) 683(73.52) | 1136(37.98) 1855(62.02) | <0.001 |
Age at onset, median(IQR) | 31.00(21.00) | 30.00(20.00) | 31.00(21.75) | 0.051 |
Duration(year), median(IQR) | 7.00(13.00) | 10.00(14.00) | 6.50(12.00) | <0.001 |
BMI, median(IQR) | 23.88(4.79) | 24.22(4.89) | 23.67(4.64) | <0.001 |
Family history, n(%) | 581(14.82) | 183(19.70) | 398(13.31) | <0.001 |
Smoking, n(%) None In the past Now Unknown | 2627(67.02) 257(6.56) 1033(26.35) 3(0.08) | 519(55.87) 85(9.15) 324(34.88) 1(0.11) | 2108(70.48) 172(5.75) 709(23.70) 2(0.07) | <0.001 |
Drug allergy history, n(%) | 236(6.02) | 79(8.50) | 157(5.25) | <0.001 |
Aggravation seasons, n(%) Spring Summer Autumn Winter No obvious seasonality Season change | 590(15.09) 304(7.76) 757(19.31) 1852(47.24) 1371(34.97) 270(6.89) | 132(14.21) 73(7.86) 155(16.68) 469(50.48) 300(32.29) 68(7.32) | 458(15.8) 231(7.72) 602(20.13) 1383(46.24) 1071(35.81) 202(6.75) | 0.411 0.893 0.020 0.024 0.050 0.552 |
Light sensitive, n (%) | 586(14.95) | 162(17.44) | 424(14.18) | 0.004 |
Comorbidity, n (%) Yes Cardiovascular disease Diabetes Respiratory system disease Hepatopathy disease Gastrointestinal disease Rheumatic immune disease Mental disease Nerve and ENT disease Malignant tumor Renal disease Allergic disease and dermatosis Others NO Unknown | 554(14.13) 261(6.66) 131(3.34) 16(0.41) 54(1.38) 25(0.64) 23(0.59) 10(0.26) 6(0.15) 7(0.18) 20(0.51) 28(0.71) 100(2.55) 3076(78.47) 290(7.40) | 194(20.88) 91(9.80) 45(4.84) 7(0.75) 14(1.51) 12(1.29) 10(1.08) 3(0.32) 5(0.54) 3(0.32) 7(0.75) 12(1.29) 44(4.74) 678(72.98) 57(7.40) | 360(12.04) 170(5.68) 86(2.88) 9(0.30) 40(1.34) 13(0.43) 13(0.43) 7(0.23) 1(0.03) 4(0.13) 13(0.43) 16(0.53) 56(1.87) 2398(80.17) 233(7.79) | <0.001 <0.001 0.004 0.059 0.698 0.004 0.025 0.923 0.003 0.454 0.233 0.017 <0.001 |
Sub-type of psoriasis, n (%) Psoriatic arthritis Erythrodermic psoriasis Pustular psoriasis Psoriasis vulgaris Mixed psoriasis | 42(1.07) 82(2.09) 112(2.86) 3575(91.20) 109(2.78) | 19(2.05) 28(3.01) 39(4.20) 794(85.47) 49(5.27) | 23(0.77) 54(1.81) 73(2.44) 2781(92.98) 60(2.01) | <0.001 |
Scalp involvement, n (%) | 2499(63.75) | 755(81.27) | 1744(58.31) | <0.001 |
Palmoplantar involvement, n (%) | 790(20.15) | 354(38.11) | 426(14.58) | <0.001 |
Genital involvement, n (%) | 522(13.32) | 240(25.83) | 282(9.43) | <0.001 |
Arthritis involvement, n (%) | 164(4.18) | 70(7.53) | 94(3.14) | <0.001 |
BSA, median(IQR) | 10.00(27.00) | 15.00(35.00) | 10.00(22.00) | <0.001 |
PASI, median(IQR) | 7.00(11.48) | 10.50(15.10) | 6.00(9.90) | <0.001 |
PEST, median(IQR) | 0.00(1.00) | 1.00(2.00) | 0.00(0.00) | <0.001 |
DLQI, median(IQR) | 8.00(10.00) | 9.00(11.00) | 7.00(10.00) | <0.001 |
Treatment satisfaction for last year, n(%) Satisfied Fair Dissatisfied Unknown | 1257(32.07) 1865(47.58) 764(19.49) 34(0.87) | 250(26.91) 427(45.96) 236(25.40) 16(1.72) | 1007(33.67) 1438(48.08) 528(17.65) 18(0.60) | <0.001 |
Characteristics | Patients (n = 929) | DLQI | p Value | PASI | p Value |
---|---|---|---|---|---|
Sex Male Female | 683 246 | 9.00(3.00,14.00) 10.00(4.00,16.80) | 0.050 | 11.40(5.40,20.10) 7.95(2.80,17.90) | <0.01 |
Age at onset <40 ≥40 | 416 513 | 9.50(4.00,16.00) 9.00(3.00,14.00) | 0.047 | 10.10(4.40,18.80) 11.30(4.65,20.20) | 0.148 |
Duration (year) <10 ≥10 | 458 471 | 9.00(3.25,14.00) 9.00(4.00,15.00) | 0.142 | 8.40(3.38,16.20) 13.40(5.90,23.00) | <0.01 |
BMI <18.5 ≥18.5, <23.9 ≥23.9, <28.0 ≥28.0, <30.0 ≥30.0 | 23 416 329 81 80 | 8.00(4.00,15.50) 9.00(3.00,14.50) 9.00(4.00,15.00) 9.00(4.00,15.00) 12.00(5.00,17.50) | 0.176 | 7.80(2.73,18.25) 9.05(3.90,18.90) 11.20(4.85,19.90) 13.90(5.20,21.60) 11.90(6.30,21.60) | 0.038 |
Family history Yes No | 183 681 | 10.00(4.00,16,75) 9.00(3.00,14.00) | 0.020 | 12.30(5.10,21.90) 10.10(4.20,19.00) | 0.030 |
Smoking Yes No | 324 604 | 10.00(4.00,16.00) 9.00(4.00,14.00) | 0.189 | 11.50(6.00,21.60) 9.85(3.90,18.60) | 0.002 |
Drug allergy history Yes No | 79 751 | 8.00(4.00,15.00) 9.00(3.00,15.00) | 0.706 | 10,80(5.40,23.90) 10.40(4.20,19.20) | 0.235 |
Light sensitive Yes No | 162 649 | 10.00(5.00,17.00) 9.00(3.50,15.00) | 0.194 | 14.05(6.95,24.90) 9.90(4.20,18.60) | <0.001 |
Comorbidity Yes No | 194 678 | 9.00(3.00,15.00) 9.00(3.00,15.00) | 0.890 | 10.65(4.90,21.60) 10.50(4.30,19.10) | 0.556 |
Scalp involvement Yes No | 755 171 | 9.00(4.00,16.00) 6.00(2.00,11.00) | <0.001 | 11.70(5.70,21.20) 4.60(1.80,12.00) | <0.001 |
Palmoplantar involvement Yes No | 354 563 | 10.00(5.00,17.00) 8.00(3.00,14.00) | <0.001 | 15.90(6.75,26.30) 8.50(3.90,26.30) | <0.001 |
Genital involvement Yes No | 240 664 | 12.00(7.00,17.00) 8.00(3.00,14.00) | <0.001 | 14.85(6.85,27.75) 9.30(3.90,18.00) | <0.001 |
Arthrosis involvement Yes No | 70 859 | 8.00(5.00,15.00) 9.00(4.00,15.00) | 0.762 | 11.40(3.50,24.40) 10.40(4.50,19.26) | 0.528 |
DLQI <6 ≥6, <10 ≥10 | 309 182 428 | 6.20(2.40,15.00) 9.80(4.76,17.93) 13.80(7.60,25.40) | <0.001 | ||
BSA <3 ≥3, <10 ≥10 | 124 207 572 | 4.00(1.00,10.00) 7.00(2.00,12.00) 10.00(5.00,17.00) | <0.001 | 1.80(0.90,2.92) 4.90(3.00,8.00) 16.80(10.25,25.85) | <0.001 |
PASI <7 ≥7, <12 ≥12 | 325 176 404 | 6.00(2,00,11.00) 10.00(5.00,15.50) 11.00(6.00,17.00) | <0.001 | ||
PEST <3 ≥3 | 749 160 | 9.00(3.00,14.00) 10.00(5.00,17.50) | 0.003 | 10.40(4.30,19.00) 11.30(4.93,25.30) | 0.193 |
Sub-type of psoriasis Psoriatic arthritis Erythrodermic psoriasis Pustular psoriasis Psoriasis vulgaris Mixed psoriasis | 42 82 112 3575 109 | 9.00(3.00,16.00) 13.00(9.00,18.00) 8.00(3.25,12.00) 8(2.00,12.00) 10(5.00,15.00) | <0.001 | 8.70(1.58–13.35) 22.80(7.95–31.85) 4.00(1.80–12.60) 6.80(3.00–14.00) 9.50(3.90–24.05) | <0.001 |
Intercept and Variable | Univariate Analysis | Multivariate Analysis | p-Value | |||
---|---|---|---|---|---|---|
β | OR (95% CI) | p-Value | β | OR (95% CI) | ||
Intercept | ||||||
Sex Female Male | 0.53 | Ref 1.70(1.44–2.00) | <0 .001 | 0.27 | Ref 1.31(1.05–1.64) | 0.017 |
Age at onset <50 ≥50 | 0.28 | 1.33(1.07–1.64) Ref | 0.009 | 0.47 | 1.60(1.21–2.21) Ref | <0 .001 |
Duration (months) <120 ≥120 | 0.47 | Ref 1.60(1.38–1.86) | < 0.001 | 0.29 | Ref 1.34(1.11–1.62) | 0.002 |
BMI(China) <18.5 ≥18.5, <23.9 ≥23.9, <27.0 ≥27.0, <30.0 ≥30.0 | 0.58 0.63 0.98 0.63 | Ref 1.78(1.13–2.80) 1.87(1.18–2.98) 2.68(1.65–4.33) 1.88(1.13–3.13) | < 0.001 0.013 0.008 <0 .001 0.015 | |||
Family history | 0.45 | 1.57(1.29–1.90) | <0 .001 | |||
Smoking No In the past Now | 0.70 0.62 | Ref 2.01(1.52–2.65) 1.86(1.58–2.18) | <0 .001 <0 .001 <0 .001 | 0.41 0.42 | Ref 1.51(1.06–2.15) 1.52(1.22–1.88) | 0.022 < 0.001 |
Drug allergy history | 0.47 | 1.61(1.21–2.13) | 0.001 | 0.41 | 1.50(1.08–2.10) | 0.025 |
Light sensitive | 0.20 | 1.23(1.00–1.50) | 0.048 | |||
Comorbidity | 0.64 | 1.91(1.57–2.31) | <0 .001 | 0.55 | 1.73(1.37–2.19) | <0 .001 |
Sub-type of psoriasis Psoriasis vulgaris Psoriatic arthritis Erythrodermic psoriasis Pustular psoriasis Mixed psoriasis | 1.06 0.60 0.63 1.05 | Ref 2.89(1.57–5.34) 1.82(1.14–2.89) 1.87(1.26–2.78) 2.86(1.95–4.21) | < 0.001 0.012 0.002 <0 .001 | 1.14 0.03 0.87 0.83 | Ref 3.12(1.41–6.94) 1.04(0.56–1.92) 2.39(1.45–3.94) 2.30(1.43–3.70) | 0.005 0.912 < 0.001 <0 .001 |
Scalp involvement | 1.13 | 3.10(2.58–3.71) | <0 .001 | 0.91 | 2.49(1.99–3.11) | <0 .001 |
Palmoplantar involvement | 1.29 | 3.63(3.07–4.30) | < 0.001 | 0.80 | 2.23(1.80–2.76) | <0 .001 |
Genital involvement | 1.22 | 3.40(2.80–4.12) | <0 .001 | 0.65 | 1.91(1.50–2.43) | <0 .001 |
Arthrosis involvement | 0.92 | 2.51(1.83–3.45) | <0 .001 | |||
DLQI <6 ≥6, <10 ≥10 | 0.04 0.46 | Ref 1.04(0.85–1.28) 1.58(1.34–1.87) | <0 .001 0.688 < 0.001 | |||
BSA <3 ≥3, <10 ≥10 | 0.35 0.70 | Ref 1.42(1.11–1.81) 2.01(1.62–2.49) | <0 .001 0.005 <0 .001 | |||
PASI <7 ≥7 | 0.75 | Ref 2.11(1.81–2.47) | <0 .001 | 0.38 | Ref 1.47(1.22–1.77) | <0 .001 |
PEST <3 ≥3 | 1.34 | Ref 3.84(3.03–4.85) | <0 .001 |
Risk Factor | Addition to Risk Score |
---|---|
Sex (male) | 3 |
Duration of psoriasis (year) ≥ 10 | 3 |
Drug allergy history | 4 |
PASI ≥ 7 | 4 |
Smoking | 4 |
Age at onset (year) < 50 | 5 |
Comorbidity | 5 |
Genital involvement | 7 |
Palmoplantar involvement | 8 |
Scalp involvement | 9 |
Sub-type of psoriasis Erythrodermic psoriasis Pustular psoriasis Mixed psoriasis Psoriatic arthritis | 8 8 8 10 |
Total score |
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Peng, Y.-T.; Yu, R.-T.; Chen, A.-J.; Wen, Z.-Y.; Xu, J.; Huang, K.; Wang, P. Predicting the Risk of Nail Involvement in Psoriasis Patients: Development and Assessment of a Predictive Nomogram. Diagnostics 2023, 13, 633. https://doi.org/10.3390/diagnostics13040633
Peng Y-T, Yu R-T, Chen A-J, Wen Z-Y, Xu J, Huang K, Wang P. Predicting the Risk of Nail Involvement in Psoriasis Patients: Development and Assessment of a Predictive Nomogram. Diagnostics. 2023; 13(4):633. https://doi.org/10.3390/diagnostics13040633
Chicago/Turabian StylePeng, Yu-Ting, Ren-Tao Yu, Ai-Jun Chen, Zhu-Yuan Wen, Jing Xu, Kun Huang, and Ping Wang. 2023. "Predicting the Risk of Nail Involvement in Psoriasis Patients: Development and Assessment of a Predictive Nomogram" Diagnostics 13, no. 4: 633. https://doi.org/10.3390/diagnostics13040633