SLESIS-R: An Improved Score for Prediction of Serious Infection in Patients with Systemic Lupus Erythematosus Based on the RELESSER Prospective Cohort

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

Meeting: ACR Convergence 2023

Keywords: Infection, risk assessment, Systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 13, 2023

Title: (1442–1487) SLE – Diagnosis, Manifestations, & Outcomes Poster II

Session Type: Poster Session B

Session Time: 9:00AM-11:00AM

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.

Disclosures: 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.

To cite this abstract in AMA style:

Rúa-Figueroa I, Garcia de Yebenes M, MARTINEZ BARRIO J, Galindo-Izquierdo M, Calvo- Alén J, Fernandez-Nebro A, Menor-Almagro R, Tomero Muriel E, Freire González M, Sanguesa Gomez C, Horcada L, Blanco R, Uriarte Isacelaya E, García-Villanueva M, Narvaez J, Rosas J, Gómez-Sabater S, Moriano Morales C, Andreu-Sánchez J, Torrente-Segarra V, Aurrecoechea Aguinaga E, Pérez Gómez A, Novoa Medina J, Salgado-Pérez E, Lozano Rivas N, Montilla-Morales C, ruiz-lucea m, Arévalo Salaet M, Iñíguez C, Expósito L, Ibáñez-Barceló M, Bonilla G, Carrión-Barberà I, Erausquin C, Pecondon-Español A, Toyos Sáenz de Miera F, Cobo T, Muñoz A, Fragio J, Oller J, Tejera Segura B, Pego-Reigosa J. SLESIS-R: An Improved Score for Prediction of Serious Infection in Patients with Systemic Lupus Erythematosus Based on the RELESSER Prospective Cohort [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/slesis-r-an-improved-score-for-prediction-of-serious-infection-in-patients-with-systemic-lupus-erythematosus-based-on-the-relesser-prospective-cohort/. Accessed .

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