Lower SLERPI cutoff improves early diagnosis in SLE patients with fever, thrombosis

Hospitalization is warranted in one in five patients with new-onset systemic lupus erythematosus (SLE) manifest disease presentations, according to a recent study. Of note, diagnosis has been delayed in nearly 20 percent of patients.

“A lower SLE Risk Probability Index (SLERPI) cutoff (≥5) in patients with fever or thrombosis could enhance early diagnosis,” the authors said.

This observational study included 855 hospitalized patients with new-onset SLE. The authors categorized clinical phenotype according to the leading manifestation that led to hospitalization and recorded disease features, time to diagnosis, classification criteria, and the SLERPI for each patient.

Of the total cohort, 191 patients (22.3 percent) were hospitalized due to manifestations eventually attributed to SLE. Neuropsychiatric syndromes (21.4 percent) were the main cause of admission, followed by cytopaenia (17.8 percent), nephritis (17.2 percent), and thrombotic events (16.2 percent).

Majority of the patients (79.5 percent) were diagnosed within 3 months from hospitalization, but 39 patients had delayed diagnosis, particularly in those with haematological manifestations.

A SLERPI >7 (indicating high probability for SLE) at hospitalization was noted in 87.4 percent of patients. Those missed by the SLERPI presented with fever, thrombotic, or neuropsychiatric manifestations not included in the algorithm.

Lowering the SLERPI threshold to 5 among patients with fever or thrombotic events improved the diagnostic rate from 88.8 percent to 97.9 percent in this subgroup. However, inclusion of all neuropsychiatric events did not increase diagnostic value.

“Prompt recognition of SLE in hospitalized patients presenting with severe disease is essential to initiate treatment,” the authors said.