Session: (1442–1487) SLE – Diagnosis, Manifestations, & Outcomes Poster II
1445: SLESIS-R: An Improved Score for Prediction of Serious Infection in Patients with Systemic Lupus Erythematosus Based on the RELESSER Prospective Cohort
Hospital de Gran Canaria Doctor Negrin Las Palmas GC, Spain
Disclosure information not submitted.
Iñigo Rúa-Figueroa1, Maria Jesus Garcia de Yebenes2, JULIA MARTINEZ BARRIO3, Maria Galindo-Izquierdo4, Jaime Calvo- Alén5, Antonio Fernandez-Nebro6, Raúl Menor-Almagro7, Eva Tomero Muriel8, Mercedes Freire González9, Clara Sanguesa Gomez10, Loreto Horcada11, Ricardo Blanco12, Esther Uriarte Isacelaya13, Maria J. García-Villanueva14, Javier Narvaez15, Jose Rosas16, Silvia Gómez-Sabater17, Clara Moriano Morales18, Jose Luis Andreu-Sánchez19, Vicente Torrente-Segarra20, Elena Aurrecoechea Aguinaga21, Ana Pérez Gómez22, Javier Novoa Medina23, Eva Salgado-Pérez24, Nuria Lozano Rivas25, Carlos Montilla-Morales26, maria esther ruiz-lucea27, Marta Arévalo Salaet28, Carlota Iñíguez29, Lorena Expósito30, Mónica Ibáñez-Barceló31, Gema Bonilla32, Irene Carrión-Barberà33, Celia Erausquin34, Angela Pecondon-Español35, Francisco Javier Toyos Sáenz de Miera36, Tatiana Cobo37, Alejandro Muñoz38, Jorge Juan Fragio39, Jose Eloy Oller40, Beatriz Tejera Segura23 and Jose-Maria Pego-Reigosa41, 1Rheumatology, Hospital de Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain, 2InMusc, Madrid, Spain, 3Rheumatology, Gregorio Marañon University Hospital, Madrid, Spain, 4Rheumatology, University Hospital of 12 de Octubre, Madrid, Spain, 5Rheumatology, Bioaraba Research Unit, Hospital Universitario Araba, Vitoria, Spain, 6Hospital Regional Universitario de Málaga, Malaga, Spain, 7Rheumatology, Hospital Jerez, Puerto De Santa María, Spain, 8Rheumatology, Hospital La Princesa, Madrid, Spain, 9Rheumatology department, Complexo Hospitalario Universitario A Coruña (CHUAC). Instituto de Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain, 10Severo Ochoa Hospital, Madrid, Spain, 11Hospital de Navarra, Pamplona, Spain, 12Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, 13Rheumatology, University Hospital of Donosti, San Sebastián, Spain, 14Hospital Ramón y Cajal, Madrid, Spain, 15Hospital Universitario de Bellvitge, Barcelona, Spain, 16Hospital Marina Baixa, Alicante, Spain, 17Rheumatology Department, Dr. Balmis University General Hospital, Alicante. Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain, 18Rheumatology, Hospital Universitario de León, León, Spain, 19Rheumatology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain, 20Department of Rheumatology, Hospital de Sant Joan Despí Moises Broggi,, Sant Joan Despí, Spain, 21Department of Rheumatology, Hospital Sierrallana, Torrelavega, Spain, 22Rheumatology, Hospital Principe de Asturias, Alcalá de Henares, Spain, 23Complejo Hospitalario Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain, 24Department of Rheumatology, University Hospital of Ourense, Ourense, Spain, 25Department of Rheumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain, 26Rheumatology, University Hospital of Salamanca, Salamanca, Spain, 27Hospita de Basurto, Bilbao, Spain, 28Rheumatology Department University Hospital Parc Taulí, Sabadell, Spain, 29Hospital Lucus Augusti, Lugo, Spain, 30Rheumatology Unit, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain, 31Rheumatology, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain, 32Department of Rheumatology, Hospital Clínico Universitario La Paz, Madrid, Spain, 33Hospital del Mar, Barcelona, Spain, 34Rheumatology Department Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain, 35Hospital Miguel Servet, Zaragoza, Spain, 36Hospital Virgen Macarena, Sevilla, Spain, 37Department of Rheumatology, Hospital Universitario Infanta Sofía, Universidad Europea, Madrid, Spain, 38Hospital universitario Virgen del Rocío, El Viso de Alcor, Spain, 39Hospital General Universitario Valencia, Valencia, Spain, 40Hospital Doctor Peset, Valencia, Spain, 41Rheumatology, Hospital do Meixoeiro, Vigo, Spain
Background/Purpose: Patients with systemic lupus erythematosus (SLE) have an increased risk of serious infections that varies with the severity of the disease, use of immunosuppressives, including glucocorticoids (GC), and damage, among others. Estimating the infection risk in these patients is important to balance the immunosuppression but there is no evidence-based and suitable tool available to make a prediction of severe infection in these patients.
The SLESIS score had been previously developed for the prediction of severe infections in SLE and was initially validated in an external cohort1. This score had 7 predictors, including the Katz index (SKI), a severity score for SLE with a limited degree of validation and difficult to implement in daily practice. Moreover, its performance was only moderate, with an AUC of 0.63 (95% CI: 0.56 - 0.70).
The objective of our study was to improve the SLESIS score in terms of prediction accuracy and feasibility.
Methods: We used the prospective phase of RELESSER (RELESSER-P), the SLE register of the Spanish Society of Rheumatology, a register that includes patients with SLE or incomplete SLE (91%≥4 ACR 1997 criteria) from 45 centers. The outcome variable was any serious infection identified over the first year of follow up, with serious infection being defined as one leading to hospitalization or death.
The sample was randomly divided into development and validation cohorts. A multivariable logistic model was populated with those variables already forming the SLESIS score, including clinical characteristics, demographic features, hospitalization by SLE comorbidities and treatments 2 plus all other potential predictors identified by literature review and available in the first visit of RELESSER-P.
The most parsimonious model with the least information criteria (AIC and BIC) were chosen as the final model. The performance of the final model was analyzed with C-statistics and AUC. Internal validation was tested using bootstrap techniques.
Results: A total of 1459 patients who had completed visit 2 (one year of follow up),or had information on infections or death in the period, were included in the development cohort (mean age of 49 ± 13, 90% females). Twenty-five (1.7%) had experienced at least one serious infection.
The results of univariate analysis are shown in Table 1.According our final, adjusted multivariate model, serious infection in SLE could be predicted from 4 variables (Table 2) and the SKI could be excluded from the model. The model correctly classified 97% of the infections with C-statistic = 0.82 (0.67 - 0.92) and a Hosmer-Lemeshow p=0.997. The AUC was 0.88 (0.80 – 0.96).
Conclusion: The revised SLESIS score (SLESIS-R) is a fairly accurate and feasible instrument to predict infections in SLE patients in the daily clinical practice that could help making informed decisions on the use of immunosuppressive or biological therapy in SLE patients.
1Tejera-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 CohortBMJ Open 2019;14;9(6):e028697.
Table 1. Univariate analysis. Variables associated with serious infection.
Table 2. Adjusted final multivariate predictive model.
I. Rúa-Figueroa: AstraZeneca, 5, GSK, 1, 6; M. Garcia de Yebenes: None; J. MARTINEZ BARRIO: None; M. Galindo-Izquierdo: None; J. Calvo- Alén: AbbVie, 2, AstraZeneca, 2, Biogen, 6, BMS, 5, Galapagos, 6, GSK, 2, 6, Lilly, 2, 6, Novartis, 2, 6, Roche, 5, Sanofi, 2; A. Fernandez-Nebro: None; R. Menor-Almagro: None; E. Tomero Muriel: None; M. Freire González: None; C. Sanguesa Gomez: None; L. Horcada: None; R. Blanco: AbbVie, 5, 6, Amgen, 6, AstraZeneca, 2, BMS, 6, Eli Lilly, 6, Galapagos, 2, 6, Janssen, 2, 6, MSD, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 5, 6, Sanofi, 6; E. Uriarte Isacelaya: None; M. García-Villanueva: AstraZeneca, 6, GSK, 6, Otsuka, 1; J. Narvaez: None; J. Rosas: None; S. Gómez-Sabater: None; C. Moriano Morales: None; J. Andreu-Sánchez: None; V. Torrente-Segarra: None; E. Aurrecoechea Aguinaga: None; A. Pérez Gómez: None; J. Novoa Medina: None; E. Salgado-Pérez: None; N. Lozano Rivas: None; C. Montilla-Morales: None; m. ruiz-lucea: None; M. Arévalo Salaet: None; C. Iñíguez: None; L. Expósito: None; M. Ibáñez-Barceló: None; G. Bonilla: None; I. Carrión-Barberà: None; C. Erausquin: AbbVie/Abbott, 12, financial support to assist meetings; A. Pecondon-Español: None; F. Toyos Sáenz de Miera: None; T. Cobo: None; A. Muñoz: None; J. Fragio: None; J. Oller: None; B. Tejera Segura: None; J. Pego-Reigosa: None.
.jpg)
