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Classifying systemic lupus erythematosus using laboratory items alone: a preliminary study

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Abstract

Objectives

To explore the performance of laboratory items alone in systemic lupus erythematosus (SLE) classification.

Methods

Our cohort consisted of 352 and 385 (control) patients with and without SLE. This study evaluated the performance of the American College of Rheumatology (ACR)-1997, Systemic Lupus International Collaborating Clinics (SLICC)-2012, European League Against Rheumatism (EULAR)/ACR-2019, and Systemic Lupus Erythematosus Risk Probability Index (SLERPI) using laboratory items alone, including blood and urine test results.

Results

The median ratio of laboratory items/total items was 66.7%, 75.0%, 60.4%, and 77.4% in ACR-1997, SLICC-2012, EULAR/ACR-2019, and SLERPI, respectively. After including laboratory items alone, the sensitivity of ACR-1997, SLICC-2012, EULAR/ACR-2019, and SLERPI was 31.3% (95% confidence interval [CI]: 26.4%–36.4%), 79.8% (95% CI: 75.3%–83.9%), 75.9% (95% CI: 71.0%–80.2%), and 85.2% (95% CI: 81.1%–88.8%), respectively. We referenced the SLERPI and removed the additional restrictions, i.e., SLICC-2012 criteria only needs to fulfill at least four items (mSLICC-2012) and EULAR/ACR-2019 criteria needs to have ≥ 10 points (mEULAR/ACR-2019) to qualify for SLE classification. The mSLICC-2012 and mEULAR/ACR-2019 criteria, including laboratory items alone, newly identified 13 and 25 patients, respectively. Based on laboratory items alone, the combination of mSLICC-2012, mEULAR/ACR-2019, and SLERPI identified 348 patients with an improved sensitivity of 90.6% (95% CI: 87.1%–93.5%). Patients, who were classified according to the mEULAR/ACR-2019 criteria, all met the other criteria.

Conclusion

Incorporating laboratory items alone was clinically feasible to help identify SLE. SLERPI and SLICC-2012, using laboratory items alone, were more worthwhile to promote in the clinic compared with EULAR/ACR-2019.

Key Points

• Laboratory items play a crucial role in the SLE classification criteria, and incorporating laboratory items alone was clinically feasible to help in the identification of SLE.

• The SLERPI and SLICC-2012, using laboratory items alone, were more worthwhile to promote in the clinic compared with EULAR/ACR-2019, and the combination of the two could further improve the sensitivity.

• The relative simplicity of evaluating laboratory indices may help nonrheumatologists and inexperienced rheumatologists to identify SLE more quickly, thereby reducing the risk of delayed diagnosis in patients.

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Data availability

The datasets used and/or analyzed during this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank all participants and staff in the Department of Rheumatology and Immunology, the Second Affiliated Hospital of Soochow University.

Funding

This study was funded by the Suzhou Science and Technology Project (SKJY2021098), the Suzhou Gusu Health Talent Plan (2022194), and Pre-research fund of the Second Affiliated Hospital of Soochow University (SDFEYJGL2102).

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Author notes

  1. Lin Zhang and Jinlu Ma contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology and Immunology, the Second Affiliated Hospital of Soochow University, Sanxiang Road No.1055, Suzhou, 215004, Jiangsu, China

    Lin Zhang, Jinlu Ma, Dong Yan, Zhichun Liu & Leixi Xue

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  1. Lin Zhang
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  2. Jinlu Ma
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Correspondence to Leixi Xue.

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Zhang, L., Ma, J., Yan, D. et al. Classifying systemic lupus erythematosus using laboratory items alone: a preliminary study. Clin Rheumatol 43, 1037–1043 (2024). https://doi.org/10.1007/s10067-024-06893-9

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  • DOI: https://doi.org/10.1007/s10067-024-06893-9

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