The Predictive Value Of Serum CD36 Levels In Cardiovascular Risk In Patients With Rheumatoid Arthritis And The Construction Of A Clinical Prediction Model

Objective: To investigate the expression and predictive value of serum CD36 levels in patients with rheumatoid arthritis（RA）cardiovascular risk and construct a multifactorial clinical prediction model based on serum CD36 levels to predict intermediate and high cardiovascular risk in RA patients and evaluate and internally validate the constructed prediction model.To provide a new theoretical basis for clinical identification and prediction of patients at moderate and high cardiovascular risk in RA patients.Methods: 84 RA patients hospitalized in the Department of Rheumatology and immunology of The second hospital of Lanzhou University in Gansu Province were selected as the research object,and 34 healthy people were selected as the control.According to the China-PAR cardiovascular risk assessment,all RA patients were divided into low cardiovascular risk groups and medium and high cardiovascular risk groups.At the same time,they were tested for serological indicators at admission,and the medical records were complete.The changes in serum CD36 levels in the RA group,healthy control group,and different cardiovascular risk groups were compared,and the correlation between serum CD36 levels and cardiovascular risk in RA patients was analyzed.Univariate analysis and multivariate logistic regression model were used to examine whether serum CD36 levels are risk factors or protective factors of high cardiovascular risk in RA patients.ROC curve was used to analyze the predictive value of CD36 on high cardiovascular risk in RA patients.Prediction models for increased cardiovascular risk in RA patients were constructed using RStudio software for column plots and evaluated using the index of concordance（C-index）,the Receiver Operating Characteristic Curve（ROC）,and the Calibration Plot,and the Decision Curve Analysis（DCA）.Results:1.Compared with the healthy control group,the number of patients with high cardiovascular risk in RA increased significantly and was negatively correlated with serum CD36（r =-0.328,P < 0.05）.2.Univariate analysis showed that age,waist circumference,diastolic blood pressure,hypertension,CRP,RF Ig A,anti-CCP,TC,TG,LDL,and serum CD36 levels were associated with high cardiovascular risk in RA patients（all P < 0.05）.3.Logistic regression analysis showed that age and diastolic blood pressure were risk factors of high cardiovascular risk in RA patients,and serum CD36 level was the protective factor of cardiovascular risk in RA patients.According to the results of Logistic regression analysis,a simple prediction equation of high cardiovascular risk in RA patients was calculated: y =-48.61 + 0.503 * age + 0.203 * Diastolic blood pressure-0.563 * CD36.The ROC curve was plotted,and the area under the curve for serum CD36 level to diagnose medium and high cardiovascular risk in RA patients was 0.691,with a cut-off value of 4.27pg/ml,sensitivity and specificity of 89.7% and 41.0%,respectively,with some predictive value.4.The Nomogram model constructed using serum CD36 level,age,and diastolic blood pressure as indicators has a high degree of differentiation,good fit,and clinical usefulness.Conclusion: 1.The serum CD36 decreases with the increase of cardiovascular risk in RA patients.A higher serum CD36 is a protective factor of cardiovascular risk in RA patients,and CD36 has a certain predictive value for cardiovascular risk in RA patients and is a potential predictor.2.The Nomogram model constructed using serum CD36,age,and diastolic blood pressure as indicators has high discrimination,consistency,and clinical utility.It has a good predictive value for medium to high cardiovascular risk in RA patients.