POS0754 DEVELOPMENT OF A RISK PREDICTION MODEL FOR VENOUS THROMBOEMBOLISM IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: THE SLE-VTE SCORE
Authors: H. You, M. Li, J. L. Zhao, L. Wu, X. Duan, H. Luo, C. Zhao, F. Zhan, Z. Wu, H. Li, M. Yang, J. Xu, W. Wei, Y. Wang, J. Shi, J. Qu, Q. Wang, X. Leng, X. Tian, Y. Zhao, X. Zeng
Journal: Annals of the Rheumatic Diseases (2021)

Background: Patients with systemic lupus erythematosus (SLE) have a substantially increased risk of venous thromboembolism (VTE). An individual VTE risk assessment is important to ensure that all patients are assessed and given adequate thromboprophylaxis. Objectives: We conducted this study to develop a risk score for VTE in patients with SLE. Methods: Patients with SLE who participated in the Chinese SLE Treatment and Research group were enrolled in this study. Patient baseline information and clinical laboratory indicators were obtained, and VTE events were recorded every 3-6 months during follow-up visits. The risk prediction model was created and internally validated using the bootstrap methods, and a scoring system was established (Figure 1). Figure 1. Flow chart of study design. Results: Out of 4,502 patients included in this study, 135 had a VTE event. After univariate analysis and Lasso regression, the following 11 variables were identified and included in the risk prediction model: male sex, age, BMI ≥25 kg/m2, hyperlipidemia, hypoalbuminemia, hsCRP&gt;3 mg/L, renal involvement, nervous system involvement, anti-β2-glycoprotein I antibody positivity, lupus anticoagulant positivity, and no use of hydroxychloroquine. The AUC for the SLE-VTE score (Table 1) was 0.947 (95% CI, 0.9249-0.9694). The SLE-VTE score’s sensitivity and specificity with the optimal cutoff value of 13 were 0.919 and 0.881, respectively. The SLE-VTE score was superior to the GAPSS system in predicting the risk of VTE in patients with SLE (AUC= 0.947 vs. 0.680, P&lt; 0.001; integrated discrimination improvement (IDI)= 0.6652, P&lt; 0.001; net reclassification improvement (NRI)= 0.6652, P&lt; 0.001). Table 1. Final multivariable analysis for venous thromboembolism risk in patients with SLE β coefficients Odds ratio* (95% CI) P-value Points in scoring system Male 0.621 1.86(0.953-3.503) 0.061 2 Age at study entry(≥50) 0.837 2.308(1.339-3.915) 0.002 3 BMI02(kg/m 2 0.792 2.209(1.333-3.627) 0.002 3 Hyperlipemia 0.838 2.313(1.246-4.166) 0.006 3 Hypoalbuminemia 2.163 8.697(5.185-14.794) &lt; 0.001 7 hsCRP&gt;3 mg/L 1.452 4.272(2.618-6.968) &lt; 0.001 5 Anti β2GPI 1.013 2.754(1.543-4.853) 0.001 3 LA 1.559 4.752(2.799-8.072) &lt; 0.001 5 Nervous system 2.382 10.832(6.163-18.998) &lt; 0.001 8 Lupus nephritis 0.835 2.305(1.414-3.756) 0.001 3 No use of hydroxychloroquine 1.771 5.876(3.722-9.401) &lt; 0.001 6 BMI: body mass index; hsCRP: Hypersensitive c-reactive protein; ACL: anticardiolipin, antiβ2GPI: anti-β2-glycoprotein I, LA: lupus anticoagulantm; Values in bold are statistically significant at p &lt;0.05. Conclusion: Various factors are related to the occurrence of VTE in patients with SLE. The proposed SLE-VTE risk score can accurately predict the risk of VTE and help identify SLE patients with a high risk of VTE who may benefit from thromboprophylaxis. References: [1]Ramirez GA, Efthymiou M, Isenberg DA, Cohen H. Under crossfire: thromboembolic risk in systemic lupus erythematosus. Rheumatology. 2018;58:940-952. [2]Chung WS, Lin CL, Chang SN, Lu CC, Kao CH. Systemic lupus erythematosus increases the risks of deep vein thrombosis and pulmonary embolism: a nationwide cohort study. J Thromb Haemost. 2014;12:452-458. [3]Liew NC, Alemany GV, Angchaisuksiri P, et al. Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism. Int Angiol. 2017;36:1. [4]Savino S, Giovanni S, Veronica M, Dario R, Khamashta MA, Laura BM. GAPSS: the Global Anti-Phospholipid Syndrome Score. Rheumatology. 2013:8. [5]Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41:543-603. [6]Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Nguyen NT, Stamos MJ. A Nationwide Analysis of Postoperative Deep Vein Thrombosis and Pulmonary Embolism in Colon and Rectal Surgery. J Gastrointest Surg. 2014;18:2169-2177. Disclosure of Interests: None declared