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  • O17 SLESIS-R: an improved score for prediction of serious infection in patients with systemic lupus erythematosus, developed from RELESSER prospective database cohort

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O17 SLESIS-R: an improved score for prediction of serious infection in patients with systemic lupus erythematosus, developed from RELESSER prospective database cohort
  1. Iñigo Rúa-Figueroa1,
  2. Maria Jesus Garcia de Yebenes2,
  3. Julia Martínez-Barrio3,
  4. María Galindo-Izquierdo4,
  5. Jaime Calvo-Alén5,
  6. Antonio Fernández-Nebro6,
  7. Raúl Menor-Almagro7,
  8. Loreto Carmona2,
  9. Beatriz García-Tejera8,
  10. Eva Tomero9,
  11. Mercedes Freire10,
  12. Clara Sanguesa11,
  13. Loreto Horcada12,
  14. Ricardo Blanco13,
  15. Esther Uriarte Isacelaya14,
  16. Javier Narváez15,
  17. José Rosas16,
  18. Silvia Gómez Sabater17,
  19. Clara Moriano18,
  20. José Luis Andréu19,
  21. Vicenç Torrente Segarra20,
  22. Elena Aurrecoechea21,
  23. Ana Pérez Gómez22,
  24. Francisco J Nóvoa8,
  25. Eva Salgado Pérez23,
  26. Nuria Lozano-Rivas24,
  27. Carlos Montilla-Morales25,
  28. Esther Ruiz-Lucea26,
  29. Marta Arévalo27,
  30. Carlota Iniguez28,
  31. Maria J García Villanueva29,
  32. Lorena Expósito30,
  33. Monica Ibañez31,
  34. Gema Bonilla Hernán32,
  35. Irene Carrión Bárbera33,
  36. Celia Erausquin1,
  37. Jorge Fragío34,
  38. Angela Pecondon-Español35,
  39. Francisco Javier Toyos36,
  40. Tatiana Cobo37,
  41. Alejandro Muñoz-Jimenez38,
  42. José Eloy Oller39 and
  43. José M Pego-Reigosa40
  1. 1Rheumatology Dept., Gran Canaria General Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain
  2. 2Rheumatology Dept., Institute for Musculoskeletal Health (InMusc), Madrid, Spain
  3. 3Rheumatology Dept., Gregorio Marañón General Hospital, Madrid, Spain
  4. 4Rheumatology Dept., University Hospital 12 de Octubre, Madrid, Spain
  5. 5Rheumatology Dept., Araba University Hospital, Vitoria, Spain
  6. 6Rheumatology Dept., Carlos Haya General Hospital, Málaga, Spain
  7. 7Rheumatology Dept., Jerez Hospital, Cádiz, Spain
  8. 8Rheumatology Dept., Insular Hospital Complex of Gran Canaria, Las Palmas de Gran Canaria., Spain
  9. 9Rheumatology Dept., La Princesa University Hospital, Madrid, Spain
  10. 10Rheumatology Dept., University Hospitality, Complex of A Coruña, A Coruña, Spain
  11. 11Rheumatology Dept., Germans Trias i Pujol University Hospital, Barcelona, Spain
  12. 12Rheumatology Dept., Hospital Complex of Navarra, Pamplona, Spain
  13. 13Rheumatology Dept., Marques de Valdecilla University Hospital, Santander, Spain
  14. 14Rheumatology Dept., University Hospital of Donostia, Donostia, Spain
  15. 15Rheumatology Dept., Hospital de Bellvitge, Barcelona, Spain
  16. 16Rheumatology Dept., Marina Baixa Hospital, Villajoyosa, Alicante, Spain
  17. 17Rheumatology Dept., University Hospital of Alicante, Alicante, Spain
  18. 18Rheumatology Dept., University Hospital of Leon, León, Spain
  19. 19Rheumatology Dept., University Hospital of Puerta del Hierro-Majadahonda, Madrid, Spain
  20. 20Rheumatology Dept., Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain
  21. 21Rheumatology Dept., Sierrallana Hospital, Torrelavega, Spain
  22. 22Rheumatology Dept., Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
  23. 23Rheumatology Dept., Orense University Complex, Orense, Spain
  24. 24Rheumatology Dept., Virgen de la Arrixaca University Hospital, Murcia, Spain
  25. 25Rheumatology Dept., University Hospital of Salamanca, Salamanca, Spain
  26. 26Rheumatology Dept., Basurto University Hospital, Bilbao, Spain
  27. 27Rheumatology Dept., Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
  28. 28Rheumatology Dept., Lucus Augusti Hospital, Lugo, Spain
  29. 29Rheumatology Dept., Ramón y Cajal University Hospital, Madrid, Spain
  30. 30Rheumatology Dept., University Clinical Hospital of Canarias, Tenerife, Spain
  31. 31Rheumatology Dept., Son Llàtzer University Hospital, Palma de Mallorca, Spain
  32. 32Rheumatology Dept., La Paz University Hospital, Madrid, Spain
  33. 33Rheumatology Dept., Del Mar Hospital, Barcelona, Spain
  34. 34Rheumatology Dept., La Fe University Hospital, Valencia, Spain
  35. 35Rheumatology Dept., Miguel Servet University Hospital, Zaragoza, Spain
  36. 36Rheumatology Dept., Virgen Macarena University Hospital, Sevilla, Spain
  37. 37Rheumatology Dept., Infanta Sofia Hospital, Madrid, Spain
  38. 38Rheumatology Dept., Virgen del Rocío University Hospital, Sevilla, Spain
  39. 39Rheumatology Dept., Dr. Peset University Hospital, Valencia, Spain
  40. 40Rheumatology Dept., IRIDIS Group, Complejo Hospitalario Universitario de Vigo, Vigo, Spain

Abstract

Objective Patients with Systemic lupus erythematosus (SLE) have a not uniform increased risk of serious infection. It is important to estimate the infection risk and balance the immunosuppression and infection risks in practice, but there is no evidence-based tool available to do it. SLESIS score, one score for prediction of severe infection, was previously developed by our group and validated in an external cohort.1 The original score incorporated up to 7 predictors and only a moderate performance of SLESIS score was observed, with AUC of 0.633. The objective of our study was to improve the SLESIS score both, as a predictor of infection and in terms of feasibility.

Methods We used data from the prospective phase of RELESSER (RELESSER-PROS), the SLE register of the Spanish Society of Rheumatology. A multivariable logistic model was constructed taking into account the variables already forming the SLESIS score, plus all other potential predictors identified in a literature review. Performance was analyzed using the C statistic and the area under the ROC (AUROC). Internal validation was carried out using a 100-sample bootstrapping procedure. OR were transformed into score items, and the AUROC was used to determine performance.

Results A total of 1459 patients who had completed 1 year of follow-up were included (mean age, 49 ± 13 years; 90% females). Twenty-five (1.7%) had experienced ≥1 severe infection. According to the adjusted multivariate model, severe infection could be predicted from 4 variables: age (years) ≥60, previous SLE-related hospitalization, previous severe infection, and glucocorticoid dose. A score was built from the best model (table 1). AUROC:0.861 (0.777–0.946). The cut-off chosen was ≥6, which exhibited an accuracy of 85.9% and a positive LR of 5.48.

Conclusions SLESIS-R is an accurate and feasible instrument for predicting infections in SLE patients. SLESIS-R could help to make informed decisions on the use of immunosuppressants and the implementation of preventive measures.

Acknowledgements Funding by GSK and Spanish Foundation of Rheumatology.

Reference

  1. Tejera-Segura B, Rúa-Figueroa I, Pego-Reigosa JM, et al. Can we validate a clinical score to predict the risk of severe infection in patients with systemic lupus erythematosus? A longitudinal retrospective study in a British Cohort BMJ Open 2019,14;9(6):e028697.

View this table:
Abstract O17 Table 1

SLESIS-R index calculator

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/lupus-2024-el.27

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