Background/Purpose:

It is well known that anti-phospholipid antibodies (aPL) are associated with an increased risk of arterial and venous thrombosis and pregnancy loss/morbidity. However, anticoagulation of aPL positive individuals is not routine due to risk of bleeding complications.  The adjusted global anti-phospholipid syndrome score (aGAPSS) takes into consideration both criteria aPL and conventional cardiovascular risk factors to predict both thrombotic and pregnancy morbidity risk and may better identify patients who need more aggressive monitoring or therapy. The aGAPSS has not been evaluated in ethnically diverse subjects. This study describes the clinical relevance of aGAPSS in a Chinese APS cohort.

Methods:

This study included 98 consecutive patients who attended the rheumatology clinic at People’s Hospital of Beijing University Health Science Center. All patients fulfilled the 2006 revised APS criteria. The criteria aPL profiles [anticardiolipin (aCL), anti-β2glycoproteinI (anti-β2GPI) and lupus anticoagulant (LA)] were assessed with an in-house assay. Hypertension was classified based on 8^thJoint National Committee (JNC-8) guideline. Hyperlipidemia was defined as fasting total cholesterol >200 mg/dl.  aGAPSS was calculated for each patient by adding points corresponding to the risk factors previously reported by Bertolaccini (3 points for hyperlipidemia, 1 point for hypertension, 5 points for aCL IgG/IgM, 4 points for anti-B2GPI IgG/IgM, 4 points for LA). Pearson Chi-squared or Fisher’s exact test univariate analysis with two tailed P value was used to evaluate correlation between aGAPSS and clinical manifestations.

Results:

Patients with APS showed a baseline aGAPSS of 8.5+/-3.3 (Mean +/- SD, range 4-16).  Primary and secondary APS patients showed aGAPSS of 8.0+/- 3.4 (range 4 -14) and 8.7 +/- 3.3 (range 4-16) respectively. There is no statistical difference in aGAPSS between primary and secondary patients, p=0.3021. No difference in aGAPSS was observed between male 8.6 +/- 3.2, (range 4-14) and female 8.5+/-3.4, (range 4-16) APS patients, p=0.86. Higher aGAPSS values were seen in patients who experienced thrombosis 9.4 +/- 3.2, (range 4-16) compared to those with pregnancy morbidity 6.7 +/- 2.8, (range 4 -14), p=0.0001.  Patients who experienced both thrombosis and pregnancy morbidity showed higher mean aGAPSS when compared to those with pregnancy morbidity alone, but it was not statistically different, p= 0.087. There is no difference in aGAPSS score among patients who experienced thrombotic recurrence [8.7+/- 3.6, (range 4-14)] compared to those without recurrence [9.7 +/- 3.0, (range 4 – 16)], p= 0.19.

Conclusion:

All patients with APS clinical manifestations had an elevated aGAPSS. Higher aGAPSS were seen in patients who experienced thrombosis than those with only pregnancy morbidities. Previously reported differences in aGAPSS among patients with recurrent thrombosis and patients with a single thromboembolic event were not observed in this cohort of Chinese APS patients. aGAPSS may be a potential quantitative tool for APS related clinical manifestations. However, further clinical examination and validation in a large multicenter and multi-ethnicity cohort with control is warranted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-and-epidemiological-correlates-of-the-adjusted-global-anti-phospholipid-syndrome-score-in-a-large-cohort-of-chinese-aps-patients/