SLESIS-R: an improved score for prediction of serious infection in patients with systemic lupus erythematosus based on the RELESSER prospective cohort

Objective: To develop an improved score for prediction of severe infection in patients with systemic lupus erythematosus (SLE), namely, the SLE Severe Infection Score-Revised (SLESIS-R) and to validate it in a large multicentre lupus cohort. Methods: We used data from the prospective phase of RELESS...

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Detalles Bibliográficos
Autores: Rua-Figueroa, Íñigo, García de Yébenes, M. Jesús, Martínez-Barrio, Julia, Galindo Izquierdo, María, Calvo Alén, Jaime, Fernández-Nebro, Antonio, Menor-Almagro, Raúl, Carmona, Loreto, Tejera Segura, Beagtriz, Tomero, Eva, Freire-González, Mercedes, Sangüesa, Clara, Horcada-Loreto, Blanco Alonso, Ricardo|||0000-0003-2344-2285, Uriarte-Itzazelaia, Esther, Narváez, Javier, Rosas Gómez de Salazar, José Carlos, Gómez-Sabater, Silvia, Moriano Moralex, Claudia, Andreu, José L.
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universidad de Cantabria (UC)
Repositorio:UCrea Repositorio Abierto de la Universidad de Cantabria
Idioma:inglés
OAI Identifier:oai:repositorio.unican.es:10902/33029
Acceso en línea:https://hdl.handle.net/10902/33029
Access Level:acceso abierto
Palabra clave:Epidemiology
Lupus erythematosus, systemic
Risk factors
Descripción
Sumario:Objective: To develop an improved score for prediction of severe infection in patients with systemic lupus erythematosus (SLE), namely, the SLE Severe Infection Score-Revised (SLESIS-R) and to validate it in a large multicentre lupus cohort. 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 analysed using the C-statistic and the area under the receiver operating characteristic curve (AUROC). Internal validation was carried out using a 100-sample bootstrapping procedure. ORs 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 in the development cohort (mean age, 49±13 years; 90% women). Twenty-five (1.7%) had experienced ≥1 severe infection. According to the adjusted multivariate model, severe infection could be predicted from four variables: age (years) ≥60, previous SLE-related hospitalisation, previous serious infection and glucocorticoid dose. A score was built from the best model, taking values from 0 to 17. The AUROC was 0.861 (0.777-0.946). The cut-off chosen was ≥6, which exhibited an accuracy of 85.9% and a positive likelihood ratio of 5.48. Conclusions: SLESIS-R is an accurate and feasible instrument for predicting infections in patients with SLE. SLESIS-R could help to make informed decisions on the use of immunosuppressants and the implementation of preventive measures.

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