Objective To evaluate the impact of laboratory results on scoring of the Physician Global Assessment (PGA) of disease activity in systemic lupus erythematosus. Methods Fifty clinical vignettes were presented via an online survey to a group of international lupus experts. For each case, respondents scored the PGA pre and post knowledge of laboratory test results (pre-lab and post-lab PGAs). Agreement between individual assessors and relationships between pre-lab and post-lab PGAs, and PGAs and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) were determined. Respondents were also asked about factors they incorporate into their PGA determinations. Results Sixty surveys were completed. The inter-rater PGA reliability was excellent (pre-lab intraclass correlation coefficient (ICC) 0.98; post-lab ICC 0.99). Post-lab PGAs were higher than pre-lab PGAs: median (IQR) pre-lab PGA 0.5 (1.05), post-lab PGA 1 (1.3) (p<0.001), with a median (IQR) difference of 0.2 (0.45). In general, all abnormal labs including elevated anti-double stranded DNA antibody level (dsDNA) and low complement impacted PGA assessment. Cases with weakest correlations between pre-lab and post-lab PGA were characterised by laboratory results revealing nephritis and/or haematological manifestations. Both pre-lab and post-lab PGAs correlated with SLEDAI-2K. However, a significantly stronger correlation was observed between post-lab PGA and SLEDAI-2K. Multiple factors influenced PGA determinations. Some factors were considered by an overwhelming majority of lupus experts, with less agreement on others. Conclusions We found excellent inter-rater reliability for PGAs in a group of international lupus experts. Post-lab PGA scores were higher than pre-lab PGA scores, with a significantly stronger correlation with the SLEDAI-2K. Our findings indicate that PGA scoring should be performed with knowledge of pertinent laboratory results.

中文翻译：

---

实验室调查结果影响医师对 SLE 疾病活动性的叶状评估 (PGA)

目的评估实验室结果对系统性红斑狼疮疾病活动性医师综合评估（PGA）评分的影响。方法通过在线调查向一组国际狼疮专家展示了 50 个临床案例。对于每种情况，受访者对 PGA 的实验室测试结果（实验室前和实验室后 PGA）的前后知识进行评分。确定了个体评估者之间的协议以及实验室前和实验室后 PGA 以及 PGA 和系统性红斑狼疮疾病活动指数 2000 (SLEDAI-2K) 之间的关系。受访者还被问及他们在 PGA 决定中纳入的因素。结果 完成了 60 次调查。评分者间 PGA 可靠性非常好（实验室前组内相关系数 (ICC) 0.98；实验室后 ICC 0.99）。实验室后 PGA 高于实验室前 PGA：中位数 (IQR) 实验室前 PGA 0.5 (1.05)，实验室后 PGA 1 (1.3) (p<0.001)，中位数 (IQR) 差异为 0.2 (0.45 ）。一般来说，所有异常实验室，包括升高的抗双链 DNA 抗体水平 (dsDNA) 和低补体都会影响 PGA 评估。实验室前和实验室后 PGA 之间相关性最弱的病例的特点是实验室结果显示肾炎和/或血液学表现。实验室前和实验室后 PGA 均与 SLEDAI-2K 相关。然而，在实验室后 PGA 和 SLEDAI-2K 之间观察到显着更强的相关性。多种因素影响 PGA 的测定。绝大多数狼疮专家都考虑了一些因素，而对其他因素则不太一致。结论 我们在一组国际狼疮专家中发现 PGA 具有出色的评分者间信度。实验室后 PGA 分数高于实验室前 PGA 分数，与 SLEDAI-2K 的相关性明显更强。我们的研究结果表明，应该在了解相关实验室结果的情况下进行 PGA 评分。