Nomogram for predicting risk of relapse following complete remission in pemphigus patients

BACKGROUND: Pemphigus is a recurrent and potentially life-threatening autoimmune bullous disease. This study aimed to develop a nomogram to predict relapse risk in pemphigus patients after complete remission (CR). METHODS: We retrospectively analyzed 110 pemphigus patients who achieved CR between 2021 and 2023 and were followed for at least 12 months. Independent predictors of relapse were identified using univariate and multivariate Cox regression analyses and incorporated into a nomogram. Model performance was evaluated using calibration curves, receiver operating characteristic (ROC) analysis, and decision curve analysis (DCA). RESULTS: During follow-up, 41.8% of patients experienced relapse. Multivariate analysis identified anemia, hypercholesterolemia, previous relapse history, elevated desmoglein (Dsg) antibody levels, and discontinuation of therapy after CR as independent risk factors. The nomogram demonstrated good discrimination with a concordance index of 0.726 (95% CI, 0.659-0.793). The AUCs for predicting relapse at 6, 12, and 18 months after achieving CR were 0.771, 0.853, and 0.811, respectively. DCA supported the clinical utility of the model, and survival analysis effectively stratified patients into high- and low-risk groups. CONCLUSION: This nomogram may serve as a practical tool for identifying pemphigus patients at high risk of relapse after CR.