Lupus Science and Medicine (Apr 2024)
SLESIS-R: an improved score for prediction of serious infection in patients with systemic lupus erythematosus based on the RELESSER prospective cohort
- Loreto Carmona,
- Carlos Montilla,
- Ricardo Blanco,
- Ana Pérez,
- Íñigo Rúa-Figueroa,
- Celia Erausquin,
- Beatriz Tejera Segura,
- Javier Narváez,
- Irene Carrión-Barberà,
- Jorge Juan Fragío Gil,
- Raúl Menor-Almagro,
- Antonio Fernández-Nebro,
- Eva Tomero,
- Esther Ruiz-Lucea,
- Julia Martínez-Barrio,
- Gema Bonilla,
- Elena Aurrecoechea,
- María Jesús García-Villanueva,
- Eva Salgado,
- Mercedes Freire-González,
- Jaime Calvo Alen,
- Tatiana Cobo,
- María Galindo Izquierdo,
- Mónica Ibáñez-Barcelo,
- Loreto Horcada,
- Lorena Expósito,
- Joan M Nolla,
- Alejandro Muñoz-Jiménez,
- Jose L Andreu,
- Clara Sanguesa,
- Nuria Lozano-Rivas,
- Marta Arévalo,
- Carlota Iniguez,
- M Jesus García de Yébenes,
- Esther Uriarte Itzazelaia,
- José Carlos Rosas Gómez de Salazar,
- Silvia Gómez-Sabater,
- Claudia Moriano Morales,
- Vicente Torrente Segarra,
- Javier Nóvoa Medina,
- Angela Pecondón,
- Francisco J Toyos,
- Jose Oller,
- J M Pego-Reigosa
Affiliations
- Loreto Carmona
- 44 Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
- Carlos Montilla
- 9 Rheumatology Department, Hospital Virgen de la Vega, Salamanca, Spain
- Ricardo Blanco
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
- Ana Pérez
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
- Íñigo Rúa-Figueroa
- 2Rheumatology, Hospital Universitario De Gran Canaria Dr. Negrín, Spain
- Celia Erausquin
- Department of Rheumatology, Hospital Doctor Negrin, Las Palmas GC, Spain
- Beatriz Tejera Segura
- 1 Centre for Rheumatology Research, University College London, London, UK
- Javier Narváez
- 7Rheumatology, Hospital Universitario De Bellvitge, Spain
- Irene Carrión-Barberà
- Department of Rheumatology, Hospital del Mar, Barcelona, Barcelona, Spain
- Jorge Juan Fragío Gil
- Rheumatology Dept., Hospital La Fe, Valencia, Spain
- Raúl Menor-Almagro
- 14Rheumatology, Hospital Universitario De Jerez, Spain
- Antonio Fernández-Nebro
- 7 UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Eva Tomero
- 13Rheumatology, Hospital Universitario De La Princesa, Spain
- Esther Ruiz-Lucea
- 1Rheumatology Dept., Basurto University Hospital, Bilbao
- Julia Martínez-Barrio
- 10Rheumatology, Hospital General Universitario Gregorio Marañón, Spain
- Gema Bonilla
- Department of Rheumatology, La Paz University Hospital, Madrid, Spain
- Elena Aurrecoechea
- Reference hospitals, Rheumatology, Internal Medicine and Pathology Units, Spain, Spain
- María Jesús García-Villanueva
- 8Rheumatology, Hospital Universitario Ramón y Cajal, Spain
- Eva Salgado
- Rheumatology Unit, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Mercedes Freire-González
- 1Pharmacy Department, La Paz University Hospital, Madrid, Spain
- Jaime Calvo Alen
- Sección de Reumatología, Hospital de Sierrallana, Torrelavega, Cantabria, Spain
- Tatiana Cobo
- Rheumatology Service, Hospital La Paz, Madrid, Spain
- María Galindo Izquierdo
- 13 Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Mónica Ibáñez-Barcelo
- 17Son LLatzer
- Loreto Horcada
- 20Complejo Hospitalario de Navarra
- Lorena Expósito
- 18Hospital Universitario de Canarias
- Joan M Nolla
- Rheumatology Department, Hospital Universitari de Bellvitge, L`Hospitalet de Llobregat, Spain
- Alejandro Muñoz-Jiménez
- 18Rheumatology, Hospital universitario Virgen Del Rocío, Spain
- Jose L Andreu
- Rheumatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Clara Sanguesa
- 11Rheumatology Dept., Germans Trias i Pujol University Hospital, Barcelona, Spain
- Nuria Lozano-Rivas
- 24Rheumatology Dept., Virgen de la Arrixaca University Hospital, Murcia, Spain
- Marta Arévalo
- 27Rheumatology Dept., Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
- Carlota Iniguez
- 28Rheumatology Dept., Lucus Augusti Hospital, Lugo, Spain
- M Jesus García de Yébenes
- Institute for Musculoskeletal Health, Madrid, Spain
- Esther Uriarte Itzazelaia
- Donostia Ospitalea, San Sebastian, Spain
- José Carlos Rosas Gómez de Salazar
- Department of Rheumatology, Marina Baixa Hospital, Alicante, Spain
- Silvia Gómez-Sabater
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
- Claudia Moriano Morales
- University Hospital Centre León, Leon, Spain
- Vicente Torrente Segarra
- Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despi, Spain
- Javier Nóvoa Medina
- Department of Rheumatology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas GC, Spain
- Angela Pecondón
- Miguel Servet University Hospital, Zaragoza, Spain
- Francisco J Toyos
- Department of Rheumatology, Hospital Virgen Macarena, Sevilla, Spain
- Jose Oller
- Doctor Peset University Hospital, Valencia, Spain
- J M Pego-Reigosa
- Department of Rheumatology, University Hospital Complex of Vigo, Vigo, Spain
- DOI
- https://doi.org/10.1136/lupus-2023-001096
- Journal volume & issue
-
Vol. 11,
no. 1
Abstract
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.