{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T04:01:40Z","timestamp":1792555300297,"version":"4.5.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of this study is to compare the clinical features and survival outcomes of class IV \u00b1 V lupus nephritis (LN) patients, identify risk factors, and develop an accurate prognostic model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study enrolled patients diagnosed with class IV \u00b1 V LN by renal biopsy at Xijing Hospital from December 2013 to June 2023. The composite endpoint of the study was defined as a decline in the estimated glomerular filtration rate (eGFR) by more than 50%, progression to end stage renal disease, or death, whichever came first. The eGFR was calculated utilizing the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. ESRD is defined as an eGFR less than 15ml\/min\/1.73m\n                      <jats:sup>2<\/jats:sup>\n                      , necessitating the commencement of chronic dialysis (hemodialysis or peritoneal dialysis) or kidney transplantation. We compared the baseline features and survival prognosis between patients with class IV \u00b1 V LN. The prognostic model was developed using machine learning algorithms and Cox regression. The model\u2019s performance was evaluated in terms of discrimination, calibration, and risk classification using the concordance index (C-index), integrated brier score (IBS), net reclassification index (NRI), and integrated discrimination improvement (IDI), respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 313 patients were enrolled for this study, including 156 class IV and 157 class IV+V LN. During the median follow-up period of 42.6 (17.0, 83.4) months, 35 (22.4%) class IV and 38 (24.2%) class IV+V LN patients experienced combined events. Class IV and class IV+V patients have similar clinical manifestations, treatment strategies, and long-term prognosis, despite class IV having a higher chronic index (CI) score (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Seven eligible variables (eGFR, CI, age, basophil percentage, red blood cell count, mean arterial blood pressure, and uric acid) were selected to develop the random survival forest (RSF) model. This model demonstrated the best performance with a C-index of 0.771 (0.667, 0.848) and an IBS of 0.144 (0.132, 0.154). The IDI and NRI in the testing set further confirmed that the RSF model exhibited superior risk classification and discrimination capabilities.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Class IV \u00b1 V LN was similar in clinical manifestations, treatment strategies, and long-term prognosis, despite differences in pathological features. The RSF model we established for class IV \u00b1 V LN patients, incorporating seven risk factors, exhibits superior survival prediction and provides more precise prognostic stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1580146","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T01:30:01Z","timestamp":1747272601000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Clinical characteristics, prognosis, and predictive modeling in class IV \u00b1 V lupus nephritis"],"prefix":"10.3389","volume":"16","author":[{"given":"Anjing","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunlong","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Xing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zixian","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liuyifei","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinguo","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueqing","family":"Hui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoshuang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiren","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.7326\/AITC202006020","article-title":"Systemic lupus erythematosus","volume":"172","author":"Kiriakidou","year":"2020","journal-title":"Ann Intern Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.jaci.2021.11.005","article-title":"Deconvoluting the heterogeneity of SLE: The contribution of ancestry","volume":"149","author":"Owen","year":"2022","journal-title":"J Allergy Clin Immunol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"102871","DOI":"10.1016\/j.jaut.2022.102871","article-title":"Lupus nephritis: new progress in diagnosis and treatment","volume":"132","author":"Yu","year":"2022","journal-title":"J Autoimmun"},{"key":"B4","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1038\/s41581-023-00722-z","article-title":"Pathogenic cellular and molecular mediators in lupus nephritis","volume":"19","author":"Mohan","year":"2023","journal-title":"Nat Rev Nephrol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2015.174","article-title":"Towards new avenues in the management of lupus glomerulonephritis","volume":"12","author":"Mok","year":"2016","journal-title":"Nat Rev Rheumatol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.10.017","article-title":"Update on lupus nephritis: core curriculum 2020","volume":"76","author":"Parikh","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-023-00925-5","article-title":"Treatment of lupus nephritis: consensus, evidence and perspectives","volume":"19","author":"Mok","year":"2023","journal-title":"Nat Rev Rheumatol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1038\/s41572-019-0141-9","article-title":"Lupus nephritis","volume":"6","author":"Anders","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2004.00443.x","article-title":"The classification of glomerulonephritis in systemic lupus erythematosus revisited","volume":"65","author":"Weening","year":"2004","journal-title":"Kidney Int"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2017.85","article-title":"Redefining lupus nephritis: clinical implications of pathophysiologic subtypes","volume":"13","author":"Yu","year":"2017","journal-title":"Nat Rev Nephrol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/01.ASN.0000108969.21691.5D","article-title":"The classification of glomerulonephritis in systemic lupus erythematosus revisited","volume":"15","author":"Weening","year":"2004","journal-title":"J Am Soc Nephrol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1177\/0961203315593166","article-title":"Long-term renal outcomes in a cohort of 1814 Chinese patients with biopsy-proven lupus nephritis","volume":"24","author":"Yang","year":"2015","journal-title":"Lupus"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1177\/09612033221088437","article-title":"Clinical characteristics and long-term outcomes in patients with mixed Class III\/IV + V and pure proliferative lupus nephritis: A single-center experience","volume":"31","author":"Ahn","year":"2022","journal-title":"Lupus"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3109\/14397595.2016.1158896","article-title":"Renal outcomes in mixed proliferative and membranous lupus nephritis (Class III\/IV\u2009+\u2009V): A long-term observational study","volume":"26","author":"Ikeuchi","year":"2016","journal-title":"Modern Rheumatol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/j.kint.2023.09.002","article-title":"KDIGO 2024 clinical practice guideline for the management of LUPUS NEPHRITIS","volume":"105","year":"2024","journal-title":"Kidney Int"},{"key":"B16","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1136\/ard-2023-224762","article-title":"EULAR recommendations for the management of systemic lupus erythematosus: 2023 update","volume":"83","author":"Fanouriakis","year":"2024","journal-title":"Ann Rheum Dis"},{"key":"B17","doi-asserted-by":"publisher","first-page":"108966","DOI":"10.1016\/j.intimp.2022.108966","article-title":"Clinical predictive model to estimate probability of remission in patients with lupus nephritis","volume":"110","author":"Kang","year":"2022","journal-title":"Int Immunopharmacol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/art.39026","article-title":"Predictors of long-term renal outcome in lupus nephritis trials: lessons learned from the Euro-Lupus Nephritis cohort","volume":"67","author":"Dall\u2019Era","year":"2015","journal-title":"Arthritis Rheumatol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1002\/art.39623","article-title":"Development of biomarker models to predict outcomes in lupus nephritis","volume":"68","author":"Wolf","year":"2016","journal-title":"Arthritis Rheumatol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/S0950-3579(05)80070-6","article-title":"Hypertension increases the risk of renal deterioration in systemic lupus erythematosus","volume":"20","author":"Ginzler","year":"1993","journal-title":"J Rheumatol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1111\/joim.2018.284.issue-6","article-title":"eDoctor: machine learning and the future of medicine","volume":"284","author":"Handelman","year":"2018","journal-title":"J Intern Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.12022","article-title":"Machine learning-based prognostic model for patients after lung transplantation","volume":"6","author":"Tian","year":"2023","journal-title":"JAMA Netw Open"},{"key":"B23","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1186\/s12967-020-02620-5","article-title":"Predicting 30-days mortality for MIMIC-III patients with sepsis-3: a machine learning approach using XGboost","volume":"18","author":"Hou","year":"2020","journal-title":"J Transl Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"g7594","DOI":"10.1161\/CIRCULATIONAHA.114.014508","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement","volume":"350","author":"Collins","year":"2015","journal-title":"BMJ"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C-based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"New Engl J Med"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.946165","article-title":"Effect of corticosteroids combined with cyclophosphamide or mycophenolate mofetil therapy for IgA nephropathy with stage 3 or 4 chronic kidney disease: A retrospective cohort study","volume":"13","author":"Jia","year":"2022","journal-title":"Front Pharmacol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2017.11.023","article-title":"Revision of the International Society of Nephrology\/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices","volume":"93","author":"Bajema","year":"2018","journal-title":"Kidney Int"},{"key":"B28","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1214\/08-AOAS169","article-title":"Random survival forests","volume":"2","author":"Ishwaran","year":"2008","journal-title":"Kidney Int"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e23436","article-title":"Prognostic factors affecting long-term outcomes in patients with concurrent IgA nephropathy and membranous nephropathy","volume":"10","author":"Qin","year":"2024","journal-title":"Heliyon"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2001.00730.x","article-title":"Significance of histologic patterns of glomerular injury upon long-term prognosis in severe lupus glomerulonephritis","volume":"59","author":"Najafi","year":"2001","journal-title":"Kidney Int"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0157485","article-title":"Comparison of outcomes between individuals with pure and mixed lupus nephritis: A retrospective study","volume":"11","author":"Ilori","year":"2016","journal-title":"PloS One"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e318233d835","article-title":"Random survival forests","volume":"6","author":"Taylor","year":"2011","journal-title":"J Thorac Oncol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1007\/s11336-014-9413-1","article-title":"Rationale and applications of survival tree and survival ensemble methods","volume":"80","author":"Zhou","year":"2015","journal-title":"Psychometrika"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1080\/10618600.2022.2067548","article-title":"Survival regression with accelerated failure time model in XGBoost","volume":"31","author":"Barnwal","year":"2022","journal-title":"J Comput Graph Stat"},{"key":"B35","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1186\/s12876-023-02949-3","article-title":"Clinical Data based XGBoost Algorithm for infection risk prediction of patients with decompensated cirrhosis: a 10-year (2012-2021) Multicenter Retrospective Case-control study","volume":"23","author":"Zheng","year":"2023","journal-title":"BMC Gastroenterol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1177\/09622802221111549","article-title":"Ensemble methods for survival function estimation with time-varying covariates","volume":"31","author":"Yao","year":"2022","journal-title":"Stat Methods Med Res"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1994.70","article-title":"Predicting renal outcomes in severe lupus nephritis: contributions of clinical and histologic data","volume":"45","author":"Austin","year":"1994","journal-title":"Kidney Int"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(99)70082-X","article-title":"Clinical and prognostic value of serial renal biopsies in lupus nephritis","volume":"34","author":"Moroni","year":"1999","journal-title":"Am J Kidney Dis"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212732","article-title":"Changing patterns in clinical-histological presentation and renal outcome over the last five decades in a cohort of 499 patients with lupus nephritis","volume":"77","author":"Moroni","year":"2018","journal-title":"Ann Rheum Dis"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaa129","article-title":"Per-protocol repeat kidney biopsy portends relapse and long-term outcome in incident cases of proliferative lupus nephritis","volume":"59","author":"Parodis","year":"2020","journal-title":"Rheumatol (Oxford)"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfv296","article-title":"Histologic versus clinical remission in proliferative lupus nephritis","volume":"32","author":"Malvar","year":"2017","journal-title":"Nephrol Dial Transplant"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1177\/09612033211061475","article-title":"Something new about prognostic factors for lupus nephritis? A systematic review","volume":"30","author":"Rodriguez-Almaraz","year":"2021","journal-title":"Lupus"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-014-0903-y","article-title":"Clinicopathological and outcome analysis of adult lupus nephritis patients in China","volume":"47","author":"Tang","year":"2015","journal-title":"Int Urol Nephrol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfy245","article-title":"Basophil involvement in lupus nephritis: a basis for innovation in daily care","volume":"34","author":"Charles","year":"2019","journal-title":"Nephrol Dial Transplant"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-017-3858-4","article-title":"Low level of circulating basophil counts in biopsy-proven active lupus nephritis","volume":"37","author":"Liang","year":"2018","journal-title":"Clin Rheumatol"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00461-5","article-title":"Acute glomerulonephritis","volume":"399","author":"Sethi","year":"2022","journal-title":"Lancet"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfad191","article-title":"A nomogram predicting the histologic activity of lupus nephritis from clinical parameters","volume":"39","author":"Gao","year":"2024","journal-title":"Nephrol Dial Transplant"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-014-2802-0","article-title":"Persistent hypertension in lupus nephritis and the associated risk factors","volume":"34","author":"Shaharir","year":"2015","journal-title":"Clin Rheumatol"},{"key":"B49","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1007\/s10157-022-02232-x","article-title":"A nationwide analysis of renal and patient outcomes for adults with lupus nephritis in Japan","volume":"26","author":"Ikeuchi","year":"2022","journal-title":"Clin Exp Nephrol"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1016\/0272-6386(95)90650-9","article-title":"Lupus nephritis in Thailand: clinicopathologic findings and outcome in 569 patients","volume":"26","author":"Shayakul","year":"1995","journal-title":"Am J Kidney Dis"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-010-1517-0","article-title":"Analysis of clinical manifestations and pathology of lupus nephritis: a retrospective review of 82 cases","volume":"29","author":"Guo","year":"2010","journal-title":"Clin Rheumatol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.cca.2020.05.034","article-title":"Uric acid and kidney damage in systemic lupus erythematosus","volume":"508","author":"Dos Santos","year":"2020","journal-title":"Clin Chim Acta"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-019-04620-3","article-title":"Is serum uric acid a predictor of long-term renal outcome in lupus nephritis","volume":"38","author":"Ugolini-Lopes","year":"2019","journal-title":"Clin Rheumatol"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.55563\/clinexprheumatol\/ar7nsq","article-title":"Elevated serum uric acid is associated with renal arteriolopathy and predict poor outcome in patients with lupus nephritis","volume":"42","author":"Wang","year":"2024","journal-title":"Clin Exp Rheumatol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1580146\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T01:30:03Z","timestamp":1747272603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1580146\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,15]]},"references-count":54,"alternative-id":["10.3389\/fimmu.2025.1580146"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1580146","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,15]]},"article-number":"1580146"}}