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Lupus Nephritis

How can early diagnosis of SLE be enhanced in hospitalized patients?

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Approximately 20% of patients with new-onset systemic lupus erythematosus (SLE) experience a delay in diagnosis despite manifesting disease presentations necessitating hospitalization, according to a study.

In this observational cohort, 855 patients with SLE were studied.

Manifestations that were eventually attributed to SLE led to the hospitalization of 191 patients (22.3%) in this cohort, with neuropsychiatric syndromes (21.4%), cytopenias (17.8%), nephritis (17.2%), and thrombotic events (16.2%) being the main causes of admission.

Most patients (79.5%) received an SLE diagnosis within months of hospitalization. A delayed diagnosis, mostly for those with hematological manifestations, was noted in 39 patients.

In 87.4% of patients, an SLE Risk Probability Index (SLERPI) of >7 was found, indicating likely SLE. Patients not identified by the SLERPI had fever, thrombotic, or neuropsychiatric manifestations not included in the algorithm.

When the SLERPI threshold was lowered to 5 for patients with fever or thrombotic events, the diagnostic rate increased from 88.8% to 97.9%.

The authors concluded that “A lower SLERPI cut-off (≥5) in patients with fever or thrombosis could enhance early diagnosis.”


Kapsala N, Nikolopoulos D, Flouda S, et al. First diagnosis of systemic lupus erythematosus in hospitalized patients: Clinical phenotypes and pitfalls for the non-specialist. Am J Med. 202:S0002-9343(21)00500-3. doi: 10.1016/j.amjmed.2021.07.015. Epub ahead of print. PMID: 34411524.