Abstract
Background
Prompt recognition of systemic lupus erythematosus (SLE) in hospitalized patients
presenting with severe disease is essential to initiate treatment. We sought to characterize
the phenotype of hospitalized patients with new-onset SLE and estimate potential diagnostic
delays.
Methods
An observational study of 855 patients (“Attikon” SLE cohort). Clinical phenotype
was categorized according to the leading manifestation that led to hospitalization.
Disease features, time to diagnosis, classification criteria, and the SLE Risk Probability
Index (SLERPI) were recorded for each patient.
Results
There were 191 patients (22.3% of the total cohort) hospitalized due to manifestations
eventually attributed to SLE. Main causes of admission were neuropsychiatric syndromes
(21.4%), cytopenias (17.8%), nephritis (17.2%), and thrombotic events (16.2%). Although
79.5% of patients were diagnosed within 3 months from hospitalization, in 39 patients
diagnosis was delayed, particularly in those with hematological manifestations. At
hospitalization, a SLERPI >7 (indicating high probability for SLE) was found in 87.4%
of patients. Patients missed by the SLERPI had fever, thrombotic or neuropsychiatric
manifestations not included in the algorithm. Lowering the SLERPI threshold to 5 in
patients with fever or thrombotic events increased the diagnostic rate from 88.8%
to 97.9% in this subgroup, while inclusion of all neuropsychiatric events yielded
no additional diagnostic value.
Conclusion
One in five patients with new-onset SLE manifest disease presentations required hospitalization.
Although early diagnosis was achieved in the majority of cases, in approximately 20%,
diagnosis was delayed. A lower SLERPI cut-off (≥5) in patients with fever or thrombosis
could enhance early diagnosis.
Keywords
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Article Info
Publication History
Published online: August 16, 2021
Footnotes
Funding: This work was funded in part by the Hellenic Society of Rheumatology; the Foundation for Research in Rheumatology (FOREUM); the Greek General Secretariat for Research and Technology 'Aristeia' action of the Operational Programme 'Education and Lifelong Learning' (co-funded by the European Social Fund and National Resources, Aristeia I 2344 to DTB); the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement no 742390); and the SYSCID (A Systems Medicine Approach to Chronic Inflammatory Diseases) under the European Union's Horizon 2020 research and innovation programme (grant agreement no 733100).
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing the manuscript.
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