The value of 2019 EULAR/ACR classification criteria in predicting lupus nephritis in childhood-onset systemic lupus erythematosus

Abstract

Background We investigated the role of European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for the prediction of LN among children with SLE.

Methods The data of the patients with childhood-onset SLE diagnosed based on 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria were retrospectively evaluated. Based on 2019 EULAR/ACR classification criteria, the scoring was done at the time of renal biopsy.

Results Fifty-two patients (12 with LN, 40 without LN) were included. The mean score was higher in patients with LN than those without (30.8±6.14, 19.8±7.76, respectively, p=0.000). The score value had indicative value for LN (area under curve [AUC]:0.863±0.055, cut-off value:22.5, p=0.000). Lymphocyte counts had a predictive value for LN (cut-off value:905/mm3, AUC:0.688±0.087, p=0.042). The score was positively associated with SLE disease activity index (SLEDAI) and activity index (r=0.879, p=0.000; r=0.811, p=0.001, respectively). There were significant negative associations between score value and GFR (r=-0.582, p=0.047). The patients with renal flare had higher the mean score than those of without renal flare (35±2/25.4±5.57, respectively, p=0.019).

Conclusions The EULAR/ACR criteria score could reflect the activity of disease and severity of nephritis in childhood-onset SLE. A point of 22.5 as score value might be an indicator for LN. During scoring, it should be taken into account that lymphopenia might guide the prediction of LN.

Zusammenfassung

Hintergrund Wir untersuchten die Rolle der Klassifizierungskriterien der European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) für die Vorhersage von LN bei Kindern mit SLE.

Methoden Es erfolgte eine retrospektive Auswertung der Daten von Patienten mit SLE im Kindesalter, deren Erkrankung anhand der Kriterien der Systemic Lupus International Collaborating Clinics (SLICC) von 2012 diagnostiziert wurde. Basierend auf den EULAR/ACR-Klassifizierungskriterien von 2019 wurde eine Beurteilung mittels Score zum Zeitpunkt der Nierenbiopsie durchgeführt.

Ergebnisse 52 Patienten (12 mit LN, 40 ohne LN) wurden eingeschlossen. Der Mittelwert war bei Patienten mit LN höher als bei Patienten ohne LN (30,8±6,14 bzw. 19,8±7,76, p=0,000). Der Score-Wert hatte einen indikativen Wert für LN (Fläche unter der Kurve [AUC]: 0,863±0,055, Grenzwert: 22,5, p=0,000). Die Anzahl der Lymphozyten hatte einen prädiktiven Wert für LN (Grenzwert: 905/mm3, AUC: 0,688±0,087, p=0,042). Der Score korrelierte positiv mit der SLE-Krankheitsaktivität (r=0,879, p=0,000; r=0,811, p=0,001). Es gab signifikante negative Korrelationen zwischen dem Score-Wert und der GFR (r=−0,582, p=0,047). Die Patienten mit akutem Schub der Nephritis hatten einen höheren Mittelwert als die Patienten ohne akuten Schub (35±2 / 25,4±5,57, p=0,019).

Schlussfolgerungen Der EULAR/ACR-Kriterien-Score könnte die Krankheitsaktivität und den Schweregrad der Nephritis bei SLE mit Beginn im Kindesalter widerspiegeln. Eine Punktzahl von 22,5 als Score-Wert könnte ein Indikator für LN sein. Bei der Score-Beurteilung sollte berücksichtigt werden, dass eine Lymphopenie bei der Vorhersage von LN als Orientierungshilfe dienen kann.

Key words

Lupus nephritis - 2019 EULAR/ACR classification criteria - children - systemic lupus erythematosus

Schlüsselwörter

Lupus nephritis - EULAR/ACR-Klassifikations kriterien 2019 - Kinder - systemischer lupus erythematodes

Publication History

Article published online:
29 March 2023

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