CE-25 From childhood to adulthood: longitudinal trajectory of damage in patients with childhood-onset systemic lupus erythematosus (CSLE)
Bibliographic record
Abstract
Background Outcomes of patients with cSLE into adulthood are poorly understood. There is no information about the longitudinal trajectory of damage in cSLE patients. We undertook this study to: 1) Determine the longitudinal damage trajectory– as measured by the ACR/SLICC SLE damage index (SDI)– in patients with cSLE. 2) Identify both baseline and disease course (time-varying) predictors of damage trajectory. Methods Single centre, retrospective, inception cohort. We included 473 patients who were diagnosed and followed, from 1st January 1985 to 30th September 2011. Patients had to be <18 years at diagnosis, have satisfied the ACR classification criteria for SLE, were treated for <3 months with steroids or an immunosuppressant for any other disease, and have had at least 3 visits. Longitudinal childhood data was obtained from our database while adulthood data was obtained from either a research database or patients’ charts. Clinical information at every visit was collected: for SLE disease activity index 2000 (SLEDAI2K), the SDI, laboratory results, and medications. Predictors were identified using a weighted generalised estimating equation (WGEE). Time-varying predictors: disease activity, individual items of SLEDAI2K, corticosteroid, immunosuppressant and antimalarial exposures, were lagged by 6, 12, 18 and 24 months prior to each visit. Results 67/473 (14%) patients were lost to follow-up. There were 14097 visits, 3290 patient-years. The median follow-up duration was 5.5 years, median age at diagnosis was 14.1 years and median age at last visit was19.5 years (range 6.0–41.9 years). 67% of patients were >18 years old at last follow-up. The predicted average population damage was 0.7 at 5 years, 1.3 at 10 years, 1.9 at 15 years, 2.3 at 20 years and 2.7 at 25 years. Cataract (14%), avascular necrosis (10%) and osteoporosis (5%) were the commonest damage items. Only 2 had myocardial infarctions. Life-threatening major organ manifestations predicted higher initial damage but the accrual slowed down over time. Higher prednisone dose (12, 24 months before) and the use of cyclophosphamide (6, 12,18, 24 months before) predicted an increased damage trajectory at current visit. Antimalarial exposure (6 months before), mucosal ulcers (6, 12, 18, 24 months before) and pericarditis (6 months before) were protective against an increase in damage trajectory. Conclusion Patients with cSLE accrue damage steadily throughout their disease course into adulthood. Baseline factors that predicted higher initial damage and influenced damage trajectory. SLE clinical features and therapeutic exposures during the course of disease, predicted a change in damage trajectory.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".