SLICC/ACR Damage Index (SDI) Score in Systemic Lupus Erythematosus Patients and its Associated Factors

Abstract

Muhammad Syahir Mohamad Fauzi, Siti Nurbaya Mohd Nawi, Hafsah Sazali, Nur Diana Mohd Yusoff and Wan Syamimee Wan Ghazali

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with irreversible organ damage. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) is widely used to quantify accumulated damage. This study aimed to determine the prevalence and associated factors of organ damage among SLE patients in a Malaysian tertiary centre.

Methods: A cross-sectional study was conducted at Hospital Pakar Universiti Sains Malaysia between 2018 and 2025. Patients fulfilling SLE classification criteria with disease duration ≥6 months were included. Data were obtained from medical records. Organ damage was assessed using the SDI. Logistic regression analyses were performed to identify associated factors.

Results: A total of 89 patients were included, with a mean age of 38.9 years and mean disease duration of 9.1 years. The majority were female (94.4%) and Malay (86.5%). Organ damage (SDI ≥1) was present in 47.2% of patients. The most common domains were ocular (12.4%) and diabetes-related damage (7.9%). Multivariable analysis identified diabetes mellitus (adjusted OR 15.3, 95% CI 1.77–132.32, p=0.013) and cyclophosphamide use (adjusted OR 5.37, 95% CI 1.89–15.30, p=0.002) as independent predictors.

Conclusion: Nearly half of SLE patients had irreversible organ damage. Diabetes mellitus and cyclophosphamide exposure were the strongest predictors. Optimizing comorbidity control and minimizing treatment toxicity are crucial to reduce long-term damage.

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