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

• Published in: Lupus science & medicine Vol. 11; no. 1; p. e001096
• Main Authors: Rua-Figueroa, Iñigo, García de Yébenes, M Jesus, Martinez-Barrio, Julia, Galindo Izquierdo, Maria, Calvo Alén, Jaime, Fernandez-Nebro, Antonio, Menor-Almagro, Raúl, Carmona, Loreto, Tejera Segura, Beatriz, Tomero, Eva, Freire-González, Mercedes, Sangüesa, Clara, Horcada, Loreto, Blanco, Ricardo, Uriarte Itzazelaia, Esther, Narváez, Javier, Rosas Gómez de Salazar, José Carlos, Gómez-Sabater, Silvia, Morales, Claudia Moriano, Andreu, Jose L, Segarra, Vicente Torrente, Aurrecoechea, Elena, Perez, Ana, Nóvoa Medina, Javier, Salgado, Eva, Lozano-Rivas, Nuria, Montilla, Carlos, Ruiz-Lucea, Esther, Arevalo, Marta, Iñiguez, Carlota, García-Villanueva, María Jesús, Exposito, Lorena, Ibáñez-Barceló, Mónica, Bonilla, Gema, Carrión-Barberà, Irene, Erausquin, Celia, Fragio Gil, Jorge Juan, Pecondón, Angela, Toyos, Francisco J, Cobo, Tatiana, Muñoz-Jiménez, Alejandro, Oller, Jose, Nolla, Joan M, Pego-Reigosa, J M
• Format: Journal Article
• Language: English
• Published: England Lupus Foundation of America 08.04.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adult; Antiparasitic agents; Clinical medicine; Co-morbidities; Comorbidity; Creatinine; Disease prevention; epidemiology; Female; Humans; Immunosuppressive Agents; Infections; Logistic Models; Lupus; lupus erythematosus, systemic; Lupus Erythematosus, Systemic - complications; Male; Middle Aged; Prospective Studies; Regression analysis; Rheumatology; risk factors; Variables; White people; lupus erythematosus, systemic; epidemiology; risk factors
• ISSN: 2053-8790; 2053-8790
• DOI: 10.1136/lupus-2023-001096

ObjectiveTo 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.MethodsWe 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.ResultsA 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.ConclusionsSLESIS-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.