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

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.