Comparison of systemic lupus international collaborating clinics 2012 classification criteria and European league against rheumatism/American college of rheumatology 2019 classification criteria for early detection of childhood onset systemic lupus erythematosus (multi-center study).

IF 1.9 4区 医学 Q3 RHEUMATOLOGY
Lupus Pub Date : 2024-05-01 Epub Date: 2024-03-27 DOI:10.1177/09612033241240830
Esraa Babgi, Munira Al Marri, Sulaiman M Al-Mayouf, Rawia Shehata, Mahmoud Majeed, Khayriah Alsufyani, Entesar Batouk, Reema Bakri, Ashwaq AlE'ed, Mada Yateem, Lujayn Akbar, Shahad Gari, Wafa Alghamdi, Abdularahman Asiri, Abdulaziz Al Rowais
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引用次数: 0

Abstract

Objective: To assess the performance of the new EULAR/ACR criteria, particularly for early detection of cSLE, in comparison to the SLICC criteria among the pediatric population in multiple centers in Saudi Arabia.

Methods: We conducted a retrospective study that enrolled pediatric patients up to the age of 14 years who've been diagnosed with SLE and followed in pediatric rheumatology clinics at 9 multi-tertiary hospitals in Saudi Arabia from 2010 to 2021 as a case group and were compared to a similar group of pediatric patients who've had defined rheumatological diseases other than SLE with a positive ANA titer (≥1:80) as controls. In total, 245 patients were included and distributed as 129 cases (diagnosed by expert pediatric rheumatologists) versus 116 patients in the control group. All relevant clinical information, including history, physical examination findings, and laboratory tests, was documented at the initial presentations. Then, the two sets of SLE classification criteria were applied to both groups to define who's going to meet both or either one of them. The exclusion criteria included those who had insufficient data or had overlapping or undifferentiated diseases. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating curve (ROC), and accuracy were calculated for SLICC 2012 and EULAR/ACR 2019 criteria (total scores≥ 10 and ≥ 13). We performed a Chi-squared test to compare sensitivity and specificity of SLICC 2012 and EULAR/ACR 2019.

Results: For SLICC (cut-off ≥4 criteria), the sensitivity was found to be 96.9% (95% CI 92.6%-99.4%) and the specificity was 94.8% (95% CI 89.6%-98.32%), with PPV and NPV of 95.4% and 96.5%, respectively. The ROC for it was 0.96 (95% CI 0.93-0.99), and this criterion had an accuracy of 95%. Regarding EULAR/ACR (total score ≥ 10), the performance measure showed a sensitivity of 99.2% and a specificity of 86.2%. Similarly, PPV was 88.9%; while NPV was a little higher (99.0%) than SLICC. The ROC for EULAR/ACR (total score ≥ 10) was 0.93 (95% CI 0.89-0.96), and this criterion had an accuracy of 93%. However, there was no statistically significant difference between the sensitivity and specificity of either using SLICC or EULAR/ACR (total score ≥ 10), as reflected by a p-value of 0.86 using the Chi-squared test. Although applying the EULAR/ACR with a total score of ≥ 13 revealed lower sensitivity (93.8%) than both the SLICC and the EULAR/ACR (total score ≥ 10), the specificity for it was found to increase up to 91.4% (85.7-96.2%) compared to the (86.2%) specificity of the EULAR/ACR (total score ≥ 10).

Conclusion: In this cohort among the Saudi population with childhood-onset SLE, the new EULAR/ACR 2019 criteria efficiently enable early detection of SLE, although a more frequent rate of false positives was observed with them. Escalating the total score from ≥ 10 to ≥ 13 in the cSLE population improved the specificity close to that of SLICC 2012. Further prospective studies in pediatrics need to be done for the validation of a cut- off score of ≥ 13 in cSLE rather than the traditional score of ≥ 10 in aSLE.

系统性红斑狼疮国际合作诊所 2012 年分类标准与欧洲抗风湿病联盟/美国风湿病学会 2019 年分类标准在儿童期发病系统性红斑狼疮早期检测方面的比较(多中心研究)。
目的评估 EULAR/ACR 新标准与 SLICC 标准在沙特阿拉伯多个中心的儿科人群中的表现,尤其是在早期发现系统性红斑狼疮方面的表现:我们进行了一项回顾性研究,将 2010 年至 2021 年期间在沙特阿拉伯 9 家三级医院的儿科风湿病诊所就诊的 14 岁以下确诊为系统性红斑狼疮的儿科患者作为病例组,并将其与 ANA 滴度阳性(≥1:80)、患有系统性红斑狼疮以外的其他风湿病的儿科患者作为对照组进行比较。该研究共纳入了 245 名患者,其中病例 129 例(由儿科风湿病专家确诊),对照组 116 例。所有相关的临床信息,包括病史、体格检查结果和实验室检查,均在初次就诊时记录在案。然后,将两套系统性红斑狼疮分类标准应用于两组患者,以确定谁符合这两套标准或其中之一。排除标准包括数据不足、疾病重叠或未分化的患者。我们计算了SLICC 2012和EULAR/ACR 2019标准(总分≥10和≥13)的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)、接收器工作曲线(ROC)和准确性。我们通过卡方检验比较了SLICC 2012和EULAR/ACR 2019的敏感性和特异性:结果:SLICC(截断值≥4标准)的敏感性为96.9%(95% CI 92.6%-99.4%),特异性为94.8%(95% CI 89.6%-98.32%),PPV和NPV分别为95.4%和96.5%。其 ROC 为 0.96(95% CI 0.93-0.99),准确率为 95%。关于 EULAR/ACR(总分≥10),性能测量的灵敏度为 99.2%,特异性为 86.2%。同样,PPV 为 88.9%;而 NPV 略高于 SLICC(99.0%)。EULAR/ACR(总分≥10)的ROC为0.93(95% CI 0.89-0.96),该标准的准确率为93%。然而,使用SLICC或EULAR/ACR(总分≥10分)的灵敏度和特异性在统计学上没有显著差异,使用Chi-squared检验的P值为0.86。虽然总分≥13分的EULAR/ACR的灵敏度(93.8%)低于SLICC和EULAR/ACR(总分≥10分),但与EULAR/ACR(总分≥10分)的特异性(86.2%)相比,其特异性增加了91.4%(85.7-96.2%):结论:在沙特儿童期系统性红斑狼疮患者队列中,EULAR/ACR 2019年新标准能有效地早期检测出系统性红斑狼疮,但假阳性率较高。在儿童系统性红斑狼疮人群中,将总分从≥10分提高到≥13分可提高特异性,接近2012年SLICC标准。需要在儿科开展进一步的前瞻性研究,以验证 cSLE 的临界值≥ 13 分,而不是 aSLE 的传统临界值≥ 10 分。
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来源期刊
Lupus
Lupus 医学-风湿病学
CiteScore
4.20
自引率
11.50%
发文量
225
审稿时长
1 months
期刊介绍: The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…
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