A validated composite model to predict risk of curve progression in adolescent idiopathic scoliosis
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AbstractBackground
In adolescent idiopathic scoliosis (AIS), the continuous search for effective prognostication of significant curve progression at the initial clinical consultation to inform decision for timely treatment and to avoid unnecessary overtreatment remains a big challenge as evidence of the multifactorial etiopathogenic nature is increasingly reported. This study aimed to formulate a composite model composed of clinical parameters and circulating markers in the prediction of curve progression.

Method
This is a two-phase study consisting of an exploration cohort (120 AIS, mean Cobb angle of 25°± 8.5 at their first clinical visit) and a validation cohort (51 AIS, mean Cobb angle of 23° ± 5.0° at the first visit). Patients with AIS were followed-up for a minimum of six years to formulate a composite model for prediction. At the first visit, clinical parameters were collected from routine clinical practice, and circulating markers were assayed from blood.

Finding
We constructed the composite predictive model for curve progression to severe Cobb angle > 40° with a high HR of 27.9 (95% CI of 6.55 to 119.16). The area under curve of the composite model is higher than that of individual parameters used in current clinical practice. The model was validated by an independent cohort and achieved a sensitivity of 72.7% and a specificity of 90%.

Interpretation
This is the first study proposing and validating a prognostic composite model consisting of clinical and circulating parameters which could quantitatively evaluate the probability of curve progression to a severe curvature in AIS at the initial consultation. Further validation in clinic will facilitate application of composite model in assisting objective clinical decision.
Acceptance Date04/12/2019
All Author(s) ListZhang Jiajun, Cheuk Ka-yee, Xu Leilei, Wang Yujia, Feng Zhenhua, Sit Tony, Cheng Ka-lo, Nepotchatykh Evguenia, Lam Tsz-ping, Liu Zhen, Hung Alec L.H., Zhu Zezhang, Moreau Alain, Cheng Jack C.Y., Qiu Yong, Lee Wayne Y.W.
Journal nameEClinicalMedicine
Year2020
Month1
Volume Number18
PublisherLancet Publishing Group
Article number100236
ISSN2589-5370
LanguagesEnglish-United Kingdom
KeywordsScoliosis, Adolescent, Clinical study, Hong Kong

Last updated on 2020-17-09 at 23:19