O17 SLESIS-R: an improved score for prediction of serious infection in patients with systemic lupus erythematosus, developed from RELESSER prospective database cohort

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Objective Patients with Systemic lupus erythematosus (SLE) have a not uniform increased risk of serious infection. It is important to estimate the infection risk and balance the immunosuppression and infection risks in practice, but there is no evidence-based tool available to do it. SLESIS score, one score for prediction of severe infection, was previously developed by our group and validated in an external cohort.1 The original score incorporated up to 7 predictors and only a moderate performance of SLESIS score was observed, with AUC of 0.633. The objective of our study was to improve the SLESIS score both, as a predictor of infection and in terms of feasibility. 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 analyzed using the C statistic and the area under the ROC (AUROC). Internal validation was carried out using a 100-sample bootstrapping procedure. OR 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 (mean age, 49 ± 13 years; 90% females). Twenty-five (1.7%) had experienced ≥1 severe infection. According to the adjusted multivariate model, severe infection could be predicted from 4 variables: age (years) ≥60, previous SLE-related hospitalization, previous severe infection, and glucocorticoid dose. A score was built from the best model (table 1). AUROC:0.861 (0.777–0.946). The cut-off chosen was ≥6, which exhibited an accuracy of 85.9% and a positive LR of 5.48. Conclusions SLESIS-R is an accurate and feasible instrument for predicting infections in SLE patients. SLESIS-R could help to make informed decisions on the use of immunosuppressants and the implementation of preventive measures. Acknowledgements Funding by GSK and Spanish Foundation of Rheumatology. Reference Tejera-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 Cohort BMJ Open 2019,14;9(6):e028697.

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