{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:38:32Z","timestamp":1787017112802,"version":"build-2736575974"},"reference-count":42,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":92,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"crossref","award":["Clinician Scientist Program NOTICE (493624887)"],"award-info":[{"award-number":["Clinician Scientist Program NOTICE (493624887)"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,9,7]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Organ damage is a key determinant of poor prognosis and increased mortality in systemic lupus erythematosus (SLE). However, no validated clinical tools for predicting damage accumulation currently exist. We sought to develop a machine learning-based model to predict early organ damage in patients with SLE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Classification criteria (American College of Rheumatology (ACR)-1997, Systemic Lupus International Collaborating Clinics (SLICC)-2012, European League Against Rheumatism (EULAR)\/ACR-2019) and non-criteria features of a cohort of 914 patients with SLE were analysed to predict damage (defined as SLICC\/ACR Damage Index (SDI)) within 5 years since diagnosis. Feature selection and model construction were performed using the least absolute shrinkage and selection operator-logistic regression (LASSO-LR). The best model in 10-fold cross-validation was tested in an external cohort (n=50).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A LASSO-LR model incorporating 16 criteria and non-criteria features predicted early organ damage with area under the receiver operating characteristic curve (AUC) values of 0.80 (95% CI 0.74 to 0.87) and 0.86 (95% CI 0.76 to 0.97) in the derivation and external validation cohorts, respectively, outperforming the ACR-1997 (AUC 0.70; 95% CI 0.62 to 0.78), SLICC-2012 (AUC 0.74; 95% CI 0.66 to 0.81) and EULAR\/ACR-2019 (AUC 0.70; 95% CI 0.63 to 0.78) classification systems. Features most strongly associated with damage included the SLICC-2012 neurological disorder, EULAR\/ACR-2019 class III\/IV lupus nephritis and among non-criteria manifestations, myocarditis and interstitial lung disease. Operating the model as a binary classifier (early damage versus no damage), it demonstrated high specificity (0.90, 95%\u2009CI 0.78 to 0.95). The model can be converted to a simplified scoring system, with a threshold of \u22653 achieving an AUC of 0.86 (95% CI 0.75 to 0.96).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We developed and validated a clinician-friendly model for early organ damage prediction in SLE, facilitating risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-006009","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T06:20:21Z","timestamp":1759299621000},"page":"e006009","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Systemic lupus erythematosus damage risk index (SLE-DRI): a simple machine learning-based tool for identifying patients at risk for early organ 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Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyridon","family":"Katechis","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0804-3198","authenticated-orcid":false,"given":"Alp","family":"Temiz","sequence":"additional","affiliation":[{"name":"Deutsches Zentrum f\u00fcr Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"},{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danae-Mona","family":"N\u00f6thling","sequence":"additional","affiliation":[{"name":"Deutsches Zentrum f\u00fcr Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"},{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7374-7795","authenticated-orcid":false,"given":"Christina","family":"Adamichou","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Bergmann","sequence":"additional","affiliation":[{"name":"Deutsches Zentrum f\u00fcr Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"},{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9607-0326","authenticated-orcid":false,"given":"Prodromos","family":"Sidiropoulos","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology, University of Crete School of Medicine, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Schett","sequence":"additional","affiliation":[{"name":"Deutsches Zentrum f\u00fcr Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"},{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2696-031X","authenticated-orcid":false,"given":"Antonis","family":"Fanouriakis","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9812-4671","authenticated-orcid":false,"given":"Dimitrios T","family":"Boumpas","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 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