Establishment and Validation of a Nomogram Model for Prediction of Diabetic Nephropathy in Type 2 Diabetic Patients with Proteinuria

Figures & data

Table 1 Comparison of Clinical Characteristics Between the Two Groups

Clinical Parameters	DN Group (n=52)	NDRD Group (n=50)	Z/t/χ^2	P value
Age [years, M (Q1,Q3)]	51 (42, 57)	54 (46, 63)	−2.371	0.018
Gender (%)			0.129	0.719
Male	33 (63.46)	30 (60)
Female	19 (36.54)	20 (40)
Hypertension (%)			13.487	<0.001
Yes	46 (88.46)	28 (56)
No	6 (11.54)	22 (44)
Tobacco smoking (%)			1.957	0.162
Yes	13 (25)	7 (14)
No	39 (75)	43 (86)
Alcohol drinking (%)			0.934	0.334
Yes	5 (9.62)	8 (16)
No	47 (90.38)	42 (84)
DR (%)			31.993	<0.001
Yes	32 (61.54)	4 (8)
No	20 (38.46)	46 (92)
BMI [kg/m2, M (Q1, Q3)]	24.97 (22.49, 26.60)	24.91 (22.41, 27.68)	−0.978	0.328
SBP (mmHg, ± s)	158.46 ± 20.23	138.12 ± 17.42	5.433	<0.001
DBP [mmHg, M (Q1, Q3)]	90 (85, 100)	80 (76, 93)	−2.886	0.004
Diabetes duration [month, M (Q1, Q3)]	72 (36, 120)	12 (6, 48)	−4.241	<0.001
HbA1c [%, M (Q1, Q3)]	8.0 (6.2, 10.4)	7.10 (6.70, 7.90)	−1.523	0.128
Hb (g/L, ±s)	115.17 ± 21.24	135.44 ± 18.47	−5.135	<0.001
FPG [mmol/L, M (Q1, Q3)]	7.40 (5.73, 10.86)	6.89 (5.60, 7.74)	−2.343	0.019
ALB [g/L, ± s]	32.79 ± 8.00	30.77 ± 9.55	1.155	0.251
TC (mmol/L, ±s)	6.23 ± 1.87	7.76 ± 2.75	−3.272	0.002
TG [mmol/L, M (Q1, Q3)]	1.84 (1.24, 2.30)	2.84 (1.78, 4.23)	−3.361	0.001
HDL-C [mmol/L, M (Q1, Q3)]	1.30 (1.05, 1.61)	1.34 (1.06, 1.62)	−1.148	0.251
LDL-C [mmol/L, M (Q1, Q3)]	3.75 (2.75, 4.79)	4.17 (3.12, 6.35)	−1.583	0.113
Cys-C [mg/L, M (Q1, Q3)]	1.26 (0.98, 1.81)	0.89 (0.71, 1.20)	−4.754	<0.001
TG/Cys-C ratio [M (Q1, Q3)]	1.32 (0.69, 1.84)	2.78 (1.82, 4.47)	−5.402	<0.001
Scr [umol/L, M (Q1, Q3)]	99 (69, 139)	69 (56, 86)	−3.816	<0.001
UA (umol/L, ± s)	330.95 ± 82.18	354.99 ± 82.21	−1.477	0.143
eGFR (mL/min/1.73m^2, ±s)	67.39 ± 35.54	97.66 ± 36.70	−4.232	<0.001
UPE, [g/24 h, M (Q1, Q3)]	4.37 (3.49, 7.60)	3.76 (1.78, 6.50)	−1.505	0.132
FIB [g/L, ± s]	4.43 ± 1.34	4.16 ± 1.15	1.074	0.286

Abbreviations: DR, diabetic retinopathy; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; HbA1c, hemoglobin A1c; Hb, hemoglobin; FPG, fasting plasma glucose; ALB, albumin; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Cys-C, cystatin C; TG/Cys-C ratio, triglyceride/cystatin C ratio; Scr, serum creatinine; UA, uric acid; eGFR, estimated glomerular filtration rate; UPE, urinary protein excretion obtained over 24 h; FIB, fibrinogen.

Table 2 Results of DN Univariate Logistic Regression Analysis

Clinical Parameters	B	S.E.	Wald	P	OR (95% CI)
Age, years	−0.043	0.019	5.083	0.024	0.958 (0.922, 0.994)
Hypertension	1.796	0.519	11.962	0.001	6.024 (2.177, 16.666)
SBP, mmHg	0.056	0.013	18.857	<0.001	1.058 (1.031, 1.085)
DBP, mmHg	0.052	0.018	7.882	0.005	1.053 (1.016, 1.092)
Diabetes duration, month	0.016	0.004	13.686	<0.001	1.106 (1.008, 1.025)
DR	2.912	0.594	24.028	<0.001	18.400 (5.742, 58.958)
HbA1c, %	0.260	0.108	5.779	0.016	1.297 (1.049, 1.603)
Hb, g/L	−0.049	0.012	17.935	<0.001	0.952 (0.930, 0.974)
FPG, mmol/L	0.245	0.083	8.721	0.003	1.278 (1.086, 1.504)
TC, mmol/L	−0.285	0.095	9.057	0.003	0.752 (0.625, 0.906)
TG, mmol/L	−0.695	0.196	12.508	<0.001	0.499 (0.340, 0.734)
LDL-C, mmol/L	−0.243	0.120	4.096	0.043	0.784 (0.620, 0.992)
Cys-C, mg/L	2.194	0.615	12.733	<0.001	8.971 (2.688, 29.934)
TG/Cys-C ratio	−0.896	0.216	17.249	<0.001	0.408 (0.267, 0.623)
Scr, µmol/L	0.010	0.004	6.085	0.014	1.010 (1.002, 1.018)
eGFR, mL/min/1.73m^2	−0.023	0.006	13.512	<0.001	0.977 (0.965, 0.989)

Abbreviations: DR, diabetic retinopathy; SBP, systolic blood pressure; DBP, diastolic blood pressure; HbA1c, hemoglobin A1c; Hb, hemoglobin; FPG, fasting plasma glucose; TC, total cholesterol; TG, triglyceride; LDL-C, low-density lipoprotein cholesterol; Cys-C, cystatin C; TG/Cys-C ratio, triglyceride/cystatin C ratio; Scr, serum creatinine; eGFR, estimated glomerular filtration rate.

Table 3 Results of Multivariate Logistic Regression Analysis of DN

Clinical Parameters	B	S.E.	Wald	P	OR (95% CI)
SBP, mmHg	0.043	0.022	3.953	0.047	1.044 (1.001, 1.089)
DR	2.735	0.908	9.072	0.003	15.416 (2.600, 91.411)
Hb, g/L	−0.056	0.021	6.967	0.008	0.946 (0.908, 0.986)
FPG, mmol/L	0.495	0.178	7.721	0.005	1.641 (1.157, 2.328)
TG/Cys-C ratio	−0.569	0.248	5.247	0.022	0.566 (0.348, 0.921)

Abbreviations: SBP, systolic blood pressure; DR, diabetic retinopathy; Hb, hemoglobin; FPG, fasting plasma glucose; TG/Cys-C ratio, triglyceride/cystatin C ratio.

Figure 1 Nomogram model for predicting DN.

Abbreviations: SBP, systolic blood pressure; DR, diabetic retinopathy; Hb, hemoglobin; FPG, fasting plasma glucose; TG/Cys-C ratio, triglyceride/cystatin C ratio.

Figure 2 ROC curve of DN risk prediction efficiency. The abscissa represents the false positive rate, which is also (1-specificity), the ordinate represents the true positive rate, which is also the sensitivity, and the area under the red curve represents the area under the ROC curve.

Figure 3 Calibration curve of nomogram model for predicting DN. New sample data set was obtained by using R4.1 software through Bootstraps method of independent sampling 2000 times, and calibration curve of DN occurrence risk line prediction was drawn. X-axis represents the probability of DN predicted by the nomogram model, and Y-axis represents the probability of DN actually diagnosed.