Albumin-to-fibrinogen ratio is an independent predictor of corticosteroid response and prognosis in patients with IgA nephropathy

BACKGROUND: The objective of this study was to investigate whether the albumin-to-fibrinogen ratio (AFR) can predict corticosteroid response and prognosis prediction among IgA nephropathy (IgAN) patients. METHODS: Eligible participants with diagnosed IgAN who were scheduled to receive corticosteroid therapy for persistent proteinuria were recruited. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of AFR or estimated glomerular filtration rate (eGFR) for corticosteroid response in IgAN patients. Risk factors for corticosteroid response and prognosis were validated using univariate and multivariate Cox proportional analyses. RESULTS: AFR and eGFR were both effective predictors of corticosteroid response in IgAN patients, with area under the curve (AUC) values of 0.686 and 0.643, respectively (P < 0.001 and P = 0.002). Baseline AFR level at biopsy was an independent risk factor for remission after corticosteroid therapy (HR: 2.38, 95% CI 1.32–4.07, P = 0.015), 50% decline in eGFR (HR: 0.78, 95% CI 0.69–0.89, P = 0.025), kidney failure (HR: 2.46, 95%CI 1.16–3.71, P = 0.016), and a composite event (HR: 2.13, 95%CI 1.28–3.34, P = 0.009) in IgAN patients. CONCLUSIONS: AFR level at biopsy was a potential predictor of corticosteroid response and prognosis among IgAN patients.