Mortality risk prediction in lupus patients complicated with invasive infection in the emergency department: LUPHAS score
Identifieur interne : 000617 ( Main/Merge ); précédent : 000616; suivant : 000618Mortality risk prediction in lupus patients complicated with invasive infection in the emergency department: LUPHAS score
Auteurs : Wanlong Wu ; Jun Ma ; Yuhong Zhou ; Chao Tang ; Feng Zhao ; Fangfang Sun ; Wenwen Xu ; Jie Chen ; Shuang Ye ; Yi ChenSource :
- Therapeutic Advances in Musculoskeletal Disease [ 1759-720X ] ; 2019.
Abstract
Infection remains a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). This study aimed to establish a clinical prediction model for the 3-month all-cause mortality of invasive infection events in patients with SLE in the emergency department.
SLE patients complicated with invasive infection admitted into the emergency department were included in this study. Patient’s demographic, clinical, and laboratory characteristics on admission were retrospectively collected as baseline data and compared between the deceased and the survivors. Independent predictors were identified by multivariable logistic regression analysis. A prediction model for all-cause mortality was established and evaluated by receiver operating characteristic (ROC) curve analysis.
A total of 130 eligible patients were collected with a cumulative 38.5%
3-month mortality. Lymphocyte count <800/ul, urea >7.6mmol/l, maximum
prednisone dose in the past ⩾60 mg/d, quick Sequential Organ Failure
Assessment (q
Based on a large emergency cohort of lupus patients complicated with invasive infection, the LUPHAS score was established to predict the short-term all-cause mortality, which could be a promising applicable tool for risk stratification in clinical practice.
Url:
DOI: 10.1177/1759720X19885559
PubMed: 31723357
PubMed Central: 6831971
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infection in the emergency department: LUPHAS score</title>
<author><name sortKey="Wu, Wanlong" sort="Wu, Wanlong" uniqKey="Wu W" first="Wanlong" last="Wu">Wanlong Wu</name>
</author>
<author><name sortKey="Ma, Jun" sort="Ma, Jun" uniqKey="Ma J" first="Jun" last="Ma">Jun Ma</name>
</author>
<author><name sortKey="Zhou, Yuhong" sort="Zhou, Yuhong" uniqKey="Zhou Y" first="Yuhong" last="Zhou">Yuhong Zhou</name>
</author>
<author><name sortKey="Tang, Chao" sort="Tang, Chao" uniqKey="Tang C" first="Chao" last="Tang">Chao Tang</name>
</author>
<author><name sortKey="Zhao, Feng" sort="Zhao, Feng" uniqKey="Zhao F" first="Feng" last="Zhao">Feng Zhao</name>
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<author><name sortKey="Sun, Fangfang" sort="Sun, Fangfang" uniqKey="Sun F" first="Fangfang" last="Sun">Fangfang Sun</name>
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<author><name sortKey="Xu, Wenwen" sort="Xu, Wenwen" uniqKey="Xu W" first="Wenwen" last="Xu">Wenwen Xu</name>
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<author><name sortKey="Chen, Jie" sort="Chen, Jie" uniqKey="Chen J" first="Jie" last="Chen">Jie Chen</name>
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<author><name sortKey="Ye, Shuang" sort="Ye, Shuang" uniqKey="Ye S" first="Shuang" last="Ye">Shuang Ye</name>
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<author><name sortKey="Chen, Yi" sort="Chen, Yi" uniqKey="Chen Y" first="Yi" last="Chen">Yi Chen</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Mortality risk prediction in lupus patients complicated with invasive
infection in the emergency department: LUPHAS score</title>
<author><name sortKey="Wu, Wanlong" sort="Wu, Wanlong" uniqKey="Wu W" first="Wanlong" last="Wu">Wanlong Wu</name>
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<author><name sortKey="Ma, Jun" sort="Ma, Jun" uniqKey="Ma J" first="Jun" last="Ma">Jun Ma</name>
</author>
<author><name sortKey="Zhou, Yuhong" sort="Zhou, Yuhong" uniqKey="Zhou Y" first="Yuhong" last="Zhou">Yuhong Zhou</name>
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<author><name sortKey="Tang, Chao" sort="Tang, Chao" uniqKey="Tang C" first="Chao" last="Tang">Chao Tang</name>
</author>
<author><name sortKey="Zhao, Feng" sort="Zhao, Feng" uniqKey="Zhao F" first="Feng" last="Zhao">Feng Zhao</name>
</author>
<author><name sortKey="Sun, Fangfang" sort="Sun, Fangfang" uniqKey="Sun F" first="Fangfang" last="Sun">Fangfang Sun</name>
</author>
<author><name sortKey="Xu, Wenwen" sort="Xu, Wenwen" uniqKey="Xu W" first="Wenwen" last="Xu">Wenwen Xu</name>
</author>
<author><name sortKey="Chen, Jie" sort="Chen, Jie" uniqKey="Chen J" first="Jie" last="Chen">Jie Chen</name>
</author>
<author><name sortKey="Ye, Shuang" sort="Ye, Shuang" uniqKey="Ye S" first="Shuang" last="Ye">Shuang Ye</name>
</author>
<author><name sortKey="Chen, Yi" sort="Chen, Yi" uniqKey="Chen Y" first="Yi" last="Chen">Yi Chen</name>
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<series><title level="j">Therapeutic Advances in Musculoskeletal Disease</title>
<idno type="ISSN">1759-720X</idno>
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<front><div type="abstract" xml:lang="en"><sec id="section1-1759720X19885559"><title>Background:</title>
<p>Infection remains a major cause of morbidity and mortality in patients with
systemic lupus erythematosus (SLE). This study aimed to establish a clinical
prediction model for the 3-month all-cause mortality of invasive infection
events in patients with SLE in the emergency department.</p>
</sec>
<sec id="section2-1759720X19885559"><title>Methods:</title>
<p>SLE patients complicated with invasive infection admitted into the emergency
department were included in this study. Patient’s demographic, clinical, and
laboratory characteristics on admission were retrospectively collected as
baseline data and compared between the deceased and the survivors.
Independent predictors were identified by multivariable logistic regression
analysis. A prediction model for all-cause mortality was established and
evaluated by receiver operating characteristic (ROC) curve analysis.</p>
</sec>
<sec id="section3-1759720X19885559"><title>Results:</title>
<p>A total of 130 eligible patients were collected with a cumulative 38.5%
3-month mortality. Lymphocyte count <800/ul, urea >7.6mmol/l, maximum
prednisone dose in the past ⩾60 mg/d, quick Sequential Organ Failure
Assessment (q<bold>S</bold>
OFA) score, and age at baseline were independent
predictors for all-cause mortality (LUPHAS). In contrast, a history of
hydroxychloroquine use was protective. In a combined, odds ratio-weighted
LUPHAS scoring system (score 3–22), patients were categorized to three
groups: low-risk (score 3–9), medium-risk (score 10–15), and high-risk
(score 16–22), with mortalities of 4.9% (2/41), 45.9% (28/61), and 78.3%
(18/23) respectively. ROC curve analysis indicated that a LUPHAS score could
effectively predict all-cause mortality [area under the curve (AUC) = 0.86,
CI 95% 0.79–0.92]. In addition, LUPHAS score performed better than the qSOFA
score alone (AUC = 0.69, CI 95% 0.59–0.78), or CURB-65 score (AUC = 0.69, CI
95% 0.59–0.80) in the subgroup of lung infections
(<italic>n</italic>
= 108).</p>
</sec>
<sec id="section4-1759720X19885559"><title>Conclusions:</title>
<p>Based on a large emergency cohort of lupus patients complicated with invasive
infection, the LUPHAS score was established to predict the short-term
all-cause mortality, which could be a promising applicable tool for risk
stratification in clinical practice.</p>
</sec>
</div>
</front>
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