Lupus(2014)23,1286–1287
SPECIAL ARTICLE
Thrombotic risk asssment in APS:the Global APS
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Score(GAPSS)
S Sciascia1,2and ML Bertolaccini1
1Graham Hughes Lupus Rearch Laboratory,Lupus Rearch Unit,The Rayne Institute,Division of Women’s Health, King’s College London,London,UK;and2Centro di Ricerche di Immunologia Clinica ed Immunopatologia
e Documentazione su Malattie Rare(CMID),Universita di Torino,Italy
Recently,we developed a risk score for antiphospholipid syndrome(APS)(Global APS Score
or GAPSS).This score derived from the combination of independent risk factors for throm-
bosis and pregnancy loss,taking into account the antiphospholipid antibodies(aPL)profile
(criteria and non-criteria aPL),the conventional cardiovascular risk factors,and the auto-
immune antibodies profile.We demonstrate that risk profile in APS can be successfully
assd,suggesting that GAPSS can be a potential quantitative marker of APS-related clin-
ical manifestations.Lupus(2014)23,1286–1287.
Key words:Antiphospholipid antibodies;pregnancy loss;thrombosis;Hughes syndrome;
prothrombin
Introduction
One of the cornerstones of health and clinical rearch is to identify individuals who have a high risk of developing an adver outcome over a specific time period,so that they can be tar-geted for early preventative strategies and possibly treatment.Many prediction models have been developed for cardiovascular dia,1,2 mainly focusing on stroke or ischaemic heart events.
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More recently,three score systems have been formulated to quantify the risk of thrombosis/ obstetric events in antiphospholipid syndrome (APS),aiming to help physicians to stratify patients according to risk.3–5Thefirst two scores3,4focud on the antiphospholipid antibodies(aPL)profile, while the most recent one,The Global APS Score or GAPSS,5also included the cardiovascular risk factors and autoimmune profile when the risk was computed.The Global APS Score(GAPSS)
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The Global APS Score(GAPSS)was designed and developed in a large cohort of patients with sys-temic lupus erythematosus(SLE).5It is derived from the combination of independent risk factors for thrombosis and pregnancy loss.GAPSS takes into account the aPL profile,including criteria6and non-criteria aPL7as well as conventional cardio-vascular risk factors such as arterial hypertension, smoking,hyperlipidaemia and diabetes and the autoimmune antibodies profile(ANA,ENA and anti-dsDNA)into the equation.
The GAPSS was developed and validated in a large cohort of concutive SLE patients who were randomly divided into two ts by a compu-ter-generated randomized list.The GAPSS was developed in thefirst t of106SLE patients, assigning weighted points proportional to the b-regression-coefficient values to each of the risk factors identified by multivariate analysis (Table1).In this cohort,higher values of GAPSS were en in patients who experienced thrombosis and/or pregn
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ancy loss compared with tho with-out clinical events(GAPSS9.3Æ4.8[range1–19] and5.3Æ4[range0–16],p<0.001).The GAPSS was then computed and validated in the cond t of105patients with SLE.In this validation cohort the results were similar,with statistically
力不从心的反义词Correspondence to:Maria Laura Bertolaccini,Graham Hughes Lupus
Rearch Laboratory,Lupus Rearch Unit,The Rayne Institute,
Division of Women’s Health,King’s College London,4th Floor
Lambeth Wing,St Thomas’Hospital,London SE17EH,UK.
Email:maria.bertolaccini@kcl.ac.uk
!The Author(s),2014.Reprints and permissions:uk/journalsPermissions.nav10.1177/0961203314541317
higher GAPSS values in patients with a clinical his-tory of thrombosis and/or pregnancy loss com-pared with tho without events(GAPSS9.5Æ5.6 [range0–20]and3.9Æ4.1[range0–17],p<0.001).
The GAPSS score was also evaluated in a cohort of51SLE patients prospectively followed-up.8In this study,we showed that an increa in the GAPSS during the follow-up(mean32.94Æ12.06 months)was en in tho SLE patients who experi-enced vascular events when compared with tho who did not experience such an event with a RR 12.30(95%CI1.43–106.13,p¼0.004).Specifically, an increa of more than3GAPSS points had the best risk accuracy for vascular events(HR48 [95%CI6.90–333.85,p¼0.0001])in this cohort.8 In order to evaluate the clinical relevance of the GAPSS in patients without an underlying connect-ive tissue dia,we recently performed a study including62concutive patients with primary APS(PAPS).9In this study,we showed that higher values of GAPSS were en in patients with PAPS who experienced thrombosis when com-pared with tho with pregnancy loss alone.In add-ition,we reported that PAPS patients who experienced recurrent thrombotic events showed higher GAPSS when compared with tho without recurrences.Interestingly,GAPSS values higher or equal to11were strongly associated with a higher risk of recurrences(OR18.27,95%CI3.74–114.5) and emed to have the best risk accuracy,in terms of nsitivity and specificity.
In summary,GAPSS is a score model bad on six clinical factors(four aPL specificities,arterial hypertension and hyperlipidaemia)that has been proven to reprent the‘probability’or likelihood of h
aving thrombosis or pregnancy loss in SLE. More recently,the clinical relevance of the GAPSS in patients without an underlying connect-ive tissue dia has also been proven.
The strength of GAPSS,when compared with the previous propod scores,lies in the inclusion of conventional cardiovascular risk factors into the computation.
GAPSS may reprent a uful tool to asss the thrombosis or pregnancy loss risk for each aPL-positive patient,switching from the concept of aPL as diagnostic antibodies to aPL as risk factors for clinical events.
Needless to say,although promising,its u should be independently validated in prospective cohorts.
Funding
MLB is funded by the Loui Gergel Fellowship. This rearch received no specific grant from any funding agency in the public,commercial,or not-for-profit ctors.
Conflict of interest statement
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The authors have no conflicts of interest to declare. References
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2Collins GS,Moons KG.Comparing risk prediction models.BMJ 2012;344:e3186.
励志工作正能量句子3Sciascia S,Cuadrado MJ,Karim MY.Management of infection in systemic lupus erythematosus.Best Pract Res Clin Rheumatol2013;
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5Sciascia S,Sanna G,Murru V,Roccatello D,Khamashta MA, Bertolaccini ML.GAPSS:The Global Anti-Phospholipid Syndrome Score.Rheumatology(Oxford)2013;52:1397–1403.
6Miyakis S,Lockshin MD,Atsumi T,et al.International connsus statement on an update of the classification criteria for definite antiphospholipid syndrome(APS).Thromb Haemost2006;4: 295–306.
7Bertolaccini ML,Amengual O,Atsumi T,et al.‘Non-criteria’aPL tests:Report of a task force and preconference workshop at the13th International Congress on Antiphospholipid Antibodies,Galveston, TX,USA,April2010.Lupus2011;20:191–205.
8Sciascia S,Sanna G,Murru V,Roccatello D,Khamashta MA, Bertolaccini ML.Prospective validation of the Global Antiphospholipid Syndrome Score(GAPSS).Arthritis Rheum 2013;65:S3.
9Sciascia S,Sanna G,Murru V,Roccatello D,Khamashta MA, Bertolaccini ML.The Global Antiphospholipid Syndrome Score (GAPSS)in primary APS.Rheumatology(Oxford)2014;in press.
读书报告怎么写Table1The Global Antiphospholipid Syndrome Score (GAPSS)
Factor Point value*
Anticardiolipin IgG/IgM5
Anti-b2-glycoprotein IgG/IgM4
Lupus anticoagulant4
Anti-prothrombin/phosphatidylrine
complex(aPS/PT)IgG/IgM
3 Hyperlipidaemia3
Arterial hypertension1
The GAPSS scoring system is derived from the combination of inde-pendent risk for both thrombosis and pregnancy loss,and accounted for multiple factors,including the patient’s aPL profile,conventional cardiovascular risk factors,autoimmune antibody profile,and throm-boprophylactic drug u.5The GAPSS can be calculated for each patient by adding the points corresponding to the different risk factors, weighted as shown in Table1.Thrombotic risk asssment in APS:the Global APS Score(GAPSS)
S Sciascia and ML Bertolaccini
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Lupus
