Analysis of the consistency of rheumatologists' clinical judgements about the necessity of immunosuppression

Author(s): Houzou P

Introduction: In cases with lupus nephritis it's necessary to define the need for immunosuppressive remedy according to histological class observed in renal vivisection. Objective: To estimate the agreement between the opinions of six independent clinical rheumatologists regarding the need for immunosuppression and the result of renal vivisection in cases with lupus nephritis.

Materials and methods: Across-sectional study on the agreement between a individual test in adult cases with systemic lupus erythematous. Each rheumatologist prognosticated the outgrowth of the vivisection. In order to estimate the agreement, a dichotomous qualitative outgrowth was defined and was considered zero if it wasn't necessary to add a cytotoxic (classes I, II and VI), and else was (classes III, IV, V or combinations). The chance agreement and kappa statistics with a confidence interval of 95 was measured.

Results: Information was collected on 34 cases, with an aggregate of 204 prognostications made by 6 rheumatology interns. Rheumatologists were correct in their clinical print in 180 cases (88.2 concordance rate, overall kappa of0.62 (95 CI = 0.48 –0.76)). Of the 204 scripts generated, 162 corresponded to proliferative forms of lupus nephritis, for which the rheumatologists anticipated the need for immunosuppression in 153 and failed to treat in 9 cases (5.5, or about 1 in 18).

Conclusions: The clinical opinion of rheumatologist is relatively successful in defining the need for immunosuppression. In general, expert opinion could ultimately be offered as an indispensable choice to renal vivisection for the case.