Thrombotic risk assessment in patients with systemic lupus erythematosus: Validation of the adjusted-Global Antiphospholipid Syndrome Score (aGAPSS) in Thai patients

Int J Rheum Dis. 2021 Dec;24(12):1510-1519. doi: 10.1111/1756-185X.14230. Epub 2021 Oct 29.

Abstract

Background: The adjusted-Global Antiphospholipid Syndrome Score (aGAPSS) has been validated and used to predict antiphospholipid antibodies (aPL) related to vascular thrombosis (VT).

Objective: To validate aGAPSS for predicted aPL-related VT and pregnancy complications (PC) in Thai systemic lupus erythematosus (SLE) patients.

Methods: A cross-sectional study was performed among Thai SLE patients with clinical manifestations; history of VT and PC, cardiovascular risk factors, and aPL profiles were collected. The aGAPSS was calculated from the sum of the risk factors (hyperlipidemia = 3.0, arterial hypertension = 1.0, anti-cardiolipin antibody = 5.0, anti-b2 glycoprotein I antibody = 4.0, and lupus anticoagulant = 4.0).

Results: Of 132 SLE patients, 12 (9.1%) had VT and 5 (4.1%) had PC. When comparing the aGAPSS (median; interquartile range [IQR]) of patients with events (VT and/or PC) (6.5; IQR 3.3-9.0), VT (8.0; IQR 4.0-9.0), arterial thrombosis (3.5; IQR 1.0-5.8), and PC (9.0; IQR 8.0-11.5), and the aGAPSS of patients without an event (3.0; IQR 0-4.0), aGAPSS of patients with events was significantly higher, except in patients with arterial thrombosis. An aGAPSS of 4.5 or more was associated with risk of aPL-related VT (sensitivity 71.4%, specificity 76.7%), and an aGAPSS of 6.0 or more was associated with risk of aPL-PC (sensitivity 100%, specificity 84.0%).

Conclusion: The aGAPSS could predict the risk of aPL-PC and aPL-related VT in Thai SLE patients.

Keywords: adjusted-Global Antiphospholipid Syndrome Score; antiphospholipid syndrome; systemic lupus erythematosus; thrombosis.

Publication types

  • Validation Study

MeSH terms

  • Aged
  • Antibodies, Antiphospholipid / blood
  • Antiphospholipid Syndrome
  • Biomarkers / blood
  • Cross-Sectional Studies
  • Female
  • Humans
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / physiopathology
  • Middle Aged
  • Pregnancy
  • Pregnancy Complications
  • ROC Curve
  • Risk Assessment
  • Thailand
  • Venous Thrombosis / diagnosis*
  • Venous Thrombosis / etiology

Substances

  • Antibodies, Antiphospholipid
  • Biomarkers