HealthDay News –  Panels of urinary biomarkers were shown to be have increased diagnostic power in predicting complete clinical responses when compared with individual biomarkers.  Combining panels of urinary biomarkers resulted in improved diagnostic test sensitivity, according to research published in Arthritis & Rheumatology. 

Noting that the American College of Rheumatology guidelines recommend change in lupus nephritis (LN) induction therapy when no response has occurred within six months, Bethany J. Wolf, PhD, from the University of South Carolina in Charleston, and colleagues analyzed biomarker models to develop a tool for defining response. 

In 140 patients with biopsy-proven LN who had not yet started induction therapy, the authors analyzed urine samples for a panel of urinary biomarkers. For each individual biomarker, they generated univariate receiver operating characteristic (ROC) curves, and compared them to the ROC area under the curve values from models developed using random forest algorithms.

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The researchers found that there was clinically meaningful predictive power for models developed with the combined traditional and novel biomarker panels. Chemokines, cytokines, and markers of cellular damage were the most predictive of response.

“This is the first study to demonstrate the power of low-abundance biomarker panels and machine learning algorithms for predicting LN outcomes,” the authors write. “This is a critical first step in research to develop clinically meaningful decision support tools.”

Summary and Clinical Applicability

“Biomarkers in the novel panels represented multiple mechanisms of disease pathogenesis and cellular damage. Thus, the effectiveness of this more inclusive approach to diagnosis… likely reflects the multistaged, heterogeneous nature of LN,” the researchers concluded.

Limitations and Disclosures

  • Several pathologists provided input for biopsy class
  • Creatinine levels were not used to normalize urinary biomarker levels

Subject materials were provided by Genentech and Bristol-Myers Squibb.

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Wolf BJ, Spainhour JC, Arthur JM, Janech MG, Petri M, Oates JC. Development of biomarker models to predict outcomes in lupus nephritis. Arthritis Rheumatol. 2016;68(8):1955-63.