Lupus & antiphospholipid syndrome
Glucocorticoid exposure and social support deficits as longitudinal predictors of long-term neuropsychiatric damage in SLE: insights from the LUMINA cohort (LXXXIII)
Authors' conclusion
In this exploratory analysis, glucocorticoid exposure and tangible social support deficits emerged as leading, potentially modifiable predictors of neuropsychiatric damage in SLE, often outranking disease activity measures
Study context
- Population
- Patients with SLE from the multiethnic LUMINA (Lupus in Minorities: Nature vs Nurture) cohort5,944 person-visit observations
- Participants
- 657 patients
- Outcome
- Organic neuropsychiatric damage (seizures, cerebrovascular accident, neuropathy, transverse myelitis) per SLICC/ACR DI
Methodological detailsmachine-learning prediction analysis of the LUMINA cohort, multiethnic, random survival forests with time-varying covariates, exploratory analysis
- Machine-learning prediction analysis of the LUMINA cohort
- Multiethnic
- Random survival forests with time-varying covariates
- Exploratory analysis
Main finding
As reported in the abstract
Patients with organic neuropsychiatric damage
92
14.0%
Incident organic events used for training
48
Random survival forest C-index (organic), outperforming Cox regression
0.738
Mean |SHAP| of current GC dose, organic damage
0.008
Observational data: associations, not effects.
Secondary outcomes
All neuropsychiatric damage (organic plus cognitive impairment/psychosis)
- Patients with any neuropsychiatric damage
- 197 (30.0%)
- Incident events used for training
- 90
- Random survival forest C-index, outperforming Cox regression
- 0.775
- Current GC dose contributed ≈2.8-fold more to model-predicted risk than for organic damage alone (mean |SHAP| 0.022 vs 0.008)
- PGA, fatigue and pain ranked highest
GC dose SHAP dependence
- Model-derived inflection in risk contribution, mg/day
- ≈40 and 60
Social determinants of health
- Contributed independently of clinical severity
Original publication
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