Seizures as a marker of severe multi-organ involvement in neuropsychiatric systemic lupus erythematosus: a diagnostic risk stratification study.

OBJECTIVE: This study aimed to identify independent predictors of seizure occurrence in patients with neuropsychiatric systemic lupus erythematosus (NPSLE), develop a diagnostic model, and evaluate whether seizures are associated with adverse renal outcomes. METHODS: A retrospective cohort of 169 patients with NPSLE from Xiangya Hospital was analyzed. Among 70 pre-specified clinical, laboratory, and imaging variables, 20 variables associated with seizure occurrence (p < 0.05 in univariable logistic regression) were retained after multicollinearity screening (VIF < 5.0). Multivariable logistic regression was then performed to identify independent predictors of SE-NPSLE. Machine learning algorithms with fivefold cross-validation were then employed to develop and optimize the diagnostic model. Model performance was evaluated using sensitivity, specificity, accuracy, and AUC metrics. External validation was performed using an independent cohort (n = 46) from Jiangsu Provincial People's Hospital. Renal survival rates were assessed by Kaplan-Meier analysis with log-rank tests. RESULTS: Independent predictors of SE-NPSLE included anti-Rib-P antibody (OR = 0.315, 95% CI: 0.121-0.819), erythrocyte sedimentation rate (ESR) (OR = 0.973 per mm/h, 95% CI: 0.954-0.992), and presence of psychosis (OR = 0.194, 95% CI: 0.057-0.659). A logistic regression-based nomogram (AUC: 0.818 training, 0.800 validation) demonstrated robust performance. External validation (n = 46) yielded an AUC of 0.706. What is more, NPSLE patients with seizures (SE-NPSLE) demonstrated significantly worse renal outcomes compared to NPSLE patients without seizures (non-SE-NPSLE). CONCLUSION: Seizures in NPSLE are associated with poor renal prognosis. Our diagnostic model was developed to facilitate early risk assessment and may aid personalized seizure management; however, its clinical utility requires validation in larger, prospective cohorts. Key Points • A validated diagnostic model indentifies high-risk NPSLE patients for seizures. • 3 independent predictors of SE-NPSLE included anti-Rib-P antibodies, ESR and psychosis. • SE-NPSLE patients were youner, had higher SLEDAI, and exhibited more severe renal dysfunction than non-SE-NPSLE patients.