Background/Purpose: The SLICC 2012 SLE classification criteria and the revised ACR-11 criteria count each SLE manifestation equally. We validated the recently proposed EULAR/ACR classification rule that uses a weighted approach against these criteria and also against a weighted version of the SLICC classification criteria.

Methods: The physician-rated patient scenarios used to develop the 2012 SLICC classification criteria were re-employed to devise a weighted SLICC classification rule. A multiple linear regression model was constructed with the 2012 SLICC criteria variables as predictors and the binary outcome (physician classification of SLE) as the outcome. To generate the weights for each criteria, we then multiplied each criteria’s coefficient by 100 and rounded to the nearest integer. The ‘Direct Coombs’ criteria (coefficient <1) was deleted for simplicity. The weights for the remaining manifestations were: acute cutaneous (26), chronic cutaneous (12), oral ulcers (16), arthritis (9), serositis (16), renal without biopsy (9), neurologic (9), hemolytic anemia (1), leukopenia or lymphopenia (14), thrombocytopenia (15), alopecia (9), ANA (17), anti-dsDNA (19), anti-Sm (16), antiphospholipid antibodies (8), low complement (11). A cutoff for classification was chosen as the score that maximized overall agreement (i.e., the sum of sensitivity and specificity) of the new weighted criteria with physician diagnosis. Patients with lupus nephritis or the new weighted classification rule of 56 or more with at least one clinical component and one immunologic component were classified as SLE. We evaluated the performance of this revised SLICC criteria, on an independent set of patient scenarios, and compared this to the performance of the older revised ACR criteria, the previous SLICC 2012 criteria, and the newly proposed EULAR/ACR criteria.

Results: Table 1 shows the performance of the four classification rules. There was no statistically significant difference (at the .05-level) between any pair of rules with respect to overall agreement with the physician diagnosis.

Table 1: Sensitivity and specificity of four different SLE classification rules based on physician diagnoses of patient scenarios

Conclusion: We validated the new EULAR/ACR criteria against both ACR-11 and SLICC classification criteria. Weighted SLICC criteria were a trade-off with less sensitivity but better specificity. The two newly derived weighted classification rules did not perform better than the existing list-based rules in terms of over-all agreement. Given that the list-based rules are easy to calculate, they may be preferred in most clinical settings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/validation-of-proposed-eular-acr-sle-classification-criteria-versus-slicc-sle-classification-criteria/