Performance of the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus in a multiethnic Malaysian cohort

Abstract

Aim To evaluate the performance of the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for systemic lupus erythematosus (SLE) in a multi‐ethnic Malaysian cohort and to compare it against the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and ACR 1997 criteria. Method We conducted a retrospective observational study of 205 patients with a diagnosis of SLE and 100 controls who formed the validation cohort. The sensitivity and specificity of the three classification criteria were evaluated and a further sub‐analysis was performed in patients with early disease and among the various ethnicities. Results The sensitivities and specificities of the three classification criteria are as follows: EULAR/ACR (90.8%; 94%), SLICC 2012 (96.1%; 94%), and ACR 1997 (82%; 96%). Among patients with early disease, the sensitivity of the SLICC 2012 was higher than that of EULAR/ACR and ACR 1997 (98% vs 94% and 86%); however, the specificity of EULAR/ACR and ACR 1997 were similar (95.2%) and higher than the SLICC 2012 (93.5%). The SLICC 2012 had higher sensitivity than that of the EULAR/ACR among the Malays (94% vs 90%), Chinese (98% vs 90%), and Indians (100% vs 95%). The specificity of the EULAR/ACR and SLICC 2012 were similar in the Malay and Chinese (93.3% each, and 92% vs 94.6%). Conclusion The EULAR/ACR performed well in our cohort. The EULAR/ACR and SLICC 2012 showed higher sensitivity than the ACR 1997, and the EULAR/ACR showed similar specificity to the ACR 1997 and SLICC 2012 overall, in early disease, and across the different ethnicities.

Utility of the ACR-1997, SLICC-2012 and EULAR/ACR-2019 classification criteria for systemic lupus erythematosus: a single-centre retrospective study

“…12 A Malaysian study published recently reported that the sensitivity of EULAR/ACR-2019 classification standard was 91% and the specificity was 94%. 15 In the present study, EULAR/ drug accuracy of 97.4%, 91.4%, According to the results of our study, the AUCs (95% CI) of ACR-1997, SLICC-2012 and EULAR/ACR-2019 were 0.972 (0.962 to 0.982), 0.986 (0.979 to 0.993) and 0.983 (0.973 to 0.992), respectively. This proved that the diagnostic results of the three sets of classification criteria were highly similar to the results of clinical diagnosis (the gold standard adopted in our study).…”

“…The sensitivity of ACR-1997, SLICC-2012 and EULAR/ACR-2019 was 86%, 98%, and 94%, respectively; and the sensitivity of SLICC-2012 was significantly higher than that of ACR-1997. 15 …”

“…The sensitivity of ACR-1997, SLICC-2012 and EULAR/ACR-2019 was 86%, 98%, and 94%, respectively; and the sensitivity of SLICC-2012 was significantly higher than that of ACR-1997. 15 In a multicentre study evaluating the causes of death in 222 patients with SLE, 31% of the deaths were attributed to active organ involvement and 33% to infection, of which the involvement of the kidney and central nervous system was the most common major cause of death. [40][41][42][43] Previous research data showed that even before the classification criteria were fully met, a certain proportion of patients with SLE may have organ-dominant or organ-localised diseases, especially the nervous system, kidney and haematological.…”

“… 7 10–16 A study conducted by Petri et al showed that the diagnostic ability was 90.0% 14 ; and in the recent case–control study, the diagnostic accuracy of EULAR/ACR-2019 classification criteria reached 91.8%. 15 Johnson et al demonstrated that the diagnostic accuracy of the EULAR/ACR-2019 was 95.4%. In addition, the study showed that sensitivities of the three sets of classification criteria in Hispanic population were higher than those in white, black and Asian population; compared with white, Hispanic and Asian population, black population had the best specificity.…”

Screening Biomarkers for Systemic Lupus Erythematosus Based on Machine Learning and Exploring Their Expression Correlations With the Ratios of Various Immune Cells

“…The clinical manifestations of SLE are heterogeneous, involving the blood, kidney, nerve and some other systems, making the treatment and management difficult and complicated (2). Currently, the Chinese hospitals often adopt European and American (EULAR/ACR) diagnostic guidelines for SLE diagnosis (3,4), whereas the molecular profiling of SLE is highly heterogeneous among different races and locations (5,6). Consequently, the specificity and sensitivity of diagnostic indicators recommended by the EULAR/ACR need to be validated further in Chinese population.…”