P123 Evaluating the performance of ACR, SLICC and EULAR/ACR classification criteria in childhood onset systemic lupus erythematosus
Authors: Abdwani Reem , Masroori Eiman Al , Abdalla Eiman , Al Abrawi Safiya , Al Zakwani Ibrahim 
Published: April 2021

Background/Aims 

The aim of the study is to compare the performance characteristics among three SLE classification criteria (ACR-1997, SLICC-2012 and EULAR/ACR-2019) in childhood onset SLE (cSLE) cohort of Arab ethnicity from Oman.

Methods 

We conducted a retrospective multicenter study among pediatric rheumatology centers in Oman. Cases were cSLE and controls were patients with other rheumatic disease with a positive ANA titer followed up over the past 10 years. Data were retrospectively collected to establish the ACR, SLICC and EULAR/ACR criteria fulfilled at first visit, first year follow up and last year of follow up.

Results 

Study population included 113 cSLE cases (mean age at diagnosis 7.3 ± 3.4 years with disease duration 6.13± 4.6 years and 38% family history of SLE) and 51 controls (mean age at diagnosis 5.0 ± 3.4 years with disease duration 5.7 ± 3.9 years and 4% family history of SLE). Table 1 demonstrates the result of the performance measures for the ACR, SLICC and EULAR/ACR criteria at first visit, first year and last follow up. P123 Table 1:Performance measures for the ACR 1997, SLICC 2012 and ACR/EULAR 2019 classification criteria according to first visit, first year and latest periods.CriteriaSensitivity (95% CI)Specificity (95% CI)PPV (95% CI)NPV (95% CI)ROC (95% CI)Accuracy (95% CI)ACR 19971st visit49% (40%-59%)96% (87%-99%)97% (88%-99%)46% (36%-56%)0.73 (0.67-0.78)64% (56%-71%)1st year57% (47-66%)96% (87%-99%)97% (90%-99%)50% (40%-60%)0.76 (0.71-0.82)69% (61%-76%)Latest66% (56%-74%)96% (87%-99%)97% (91%-99%)56% (45%-66%)0.81 (0.76-0.86)75% (68%-81%)SLICC1st visit76% (67%-84%)94% (84%-99%)97% (91%-99%)64% (52%-75%)0.85 (0.80-0.90)82% (75%-87%)1st year84% (76%-90%)94% (84%-99%)97% (91%-99%)73% (60%-83%)0.89 (0.84-0.94)87% (81%-92%)Latest86% (78%-92%)94% (84%-99%)97% (92%-99%)75% (63%-85%)0.90 (0.85-0.95)88% (83%-93%)ACR/EULAR1st visit81% (73%-88%)92% (81%-98%)96% (90%-99%)69% (57%-80%)0.87 (0.82-0.92)85% (78%-90%)1st year88% (80%-93%)90% (79%-97%)95% (89%-98%)77% (64%-87%)0.89 (0.84-0.94)88% (83%-93%)Latest89% (82%-94%)90% (79%-97%)95% (89%-99%)79% (67%-89%)0.90 (0.85-0.95)90% (84%-94%)ACR/EULAR*1st visit76% (67%-84%)96% (87%-99%)98% (92%-99%)65% (53%-75%)0.86 (0.81-0.91)83% (76%-88%)1st year83% (74%-89%)96% (87%-99%)98% (93%-99%)71% (59%-81%)0.89 (0.85-0.94)87% (81%-92%)Latest84% (76%-90%)96% (87%-99%)98% (93%-99%)73% (61%-83%)0.90 (0.86-0.94)88% (83%-93%)ACR, American College of Rheumatology 1997; SLICC, Systemic Lupus Erythematosus International Collaborating Clinics; EULAR, European League Against Rheumatism; CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value; ROC, area under the received operating curve. ACR/EULAR*, a score of ≥ 13 as compared to the traditional cut of score of ≥ 10. The median disease duration was 5 (2.5-9) years with a range of 1-19 years.

Conclusion 

In this cSLE population, the EULAR/ACR criteria scored better in sensitivity at first, one year and last follow up; while the ACR 1997 scored better in specificity at first, one year and last follow up. However, if the EULAR/ACR cut score ≥ 13 (rather than traditional cut-score ≥ 10) then it an equivalent specificity to ACR 1997 at the expense of lower sensitivity.

Disclosure 

R. Abdwani: None. E. Al Masroori: None. E. Abdalla: None. S. Al Abrawi: None. I. Al Zakwani: None.