ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 5

Clinical Utility of the Global Antiphospholipid Syndrome Score (GAPSS) for Risk Stratification: A Pooled Analysisfrom 2273 Patients

Savino Sciascia1, Massimo Radin2, Giovanni Sanna3, Irene Cecchi4, Dario Roccatello5 and Maria Laura Bertolaccini6, 1Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, Italy, Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, Italy, Torino, Italy, 2Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, Italy, Turin, Italy, 3Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, London, United Kingdom, 4Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, Italy, Turin, Italy, 5Center of Research of Immunopathology and Rare Diseases- Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, University of Turin and S. Giovanni Bo, Turin, Italy, 6Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, United Kingdom, London, United Kingdom

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: , , ,

Session Information

Date: Sunday, November 5, 2017

Session Title: Antiphospholipid Syndrome Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Recently, our group conceived a risk score for clinical manifestations of APS [the global APS score or GAPSS] that takes into account the combination of independent cardiovascular risk factors and the aPL positivity profile. These include hyperlipidemia, arterial hypertension, aCL, anti-b2GPI, aPS/PT and the LA. A complementary version, the adjusted GAPSS or aGAPSS, which excludes aPS/PT, was also designed.

Methods:

We pooled data from available cohort studies, including a total of 10 studies, counting for a total of 2273 patients in which the GAPSS score has been applied. A search strategy was developed a priori to identify available cohort that reported findings that investigated the clinical utility of GAPSS or aGAPSS score.

Results:

When pooling together available data, GAPSS/aGAPSS was applied in a total of 2273 patients. Studies characteristics and patients enrolled are summarized in Table 1.

Seven studies used the GAPSS in their cohort, whether three studies used the aGAPSS. In brief, we found a statistically significant difference in the cumulative GAPSS and aGAPSS scores between patients that experienced arterial and/or venous thrombotic event (Cumulative GAPSS 10.6±4.74 and aGAPSS 7.6±3.95), patients without any thrombotic manifestation (Cumulative GAPSS 7.01±5.46 and aGAPSS 4.9±4.33) and patients with pregnancy morbidity (Cumulative GAPSS 8.79±2.59 and aGAPSS 6.7±2.8).

The highest levels of GAPSS were found in patients that experienced arterial thrombosis (mean GAPSS 12.2±5.2) and patients that experienced any recurrences of clinical manifestations of APS (mean GAPSS 13.7±3.1).

Conclusion:

GAPSS may represent a useful tool to assess the thrombosis or pregnancy loss risk in aPL positive patient, switching from the concept of aPL as a sole diagnostic antibody to aPL as risk factors for clinical events. A risk assessment, using appropriate tools as GAPSS, should be implemented to identify and monitor those patients at a higher risk of recurrences and those needing a strict control of all modifiable risk factor for cardiovascular events; in agreement with the above, in the future the management of APS should also modulate according to the GAPSS values.

Table 1. Demographic, clinical and laboratory characteristics of the cohort

STUDY

YEAR

STUDY DESIGN

AIM

NUMBER OF PATIENTS

PATIENTS’ CHARACTERISTICS

Sciascia et al.

 

2013

Cross-Sectional

To validate the first GAPSS score with a validation cohort

105

SLE

Sciascia et al.

 

2014

Prospective

To prospectively and independently validate GAPSS, with a follow-up of mean 32.94 (SD 12.06) months

51

SLE aPL positive patients

Zuily et al.

 

2015

Prospective

To investigate the validity of the global APS score (GAPSS) to predict thrombosis in patients
with autoimmune diseases, followed up
for a mean duration of 43.1 (S.D. 20.7) months

137

patients with aPL and/or SLE

Oku et al.

 

2015

Retrospective

To validate the GAPSS independently

282

41 APS (17 PAPS) patients, 88 SLE without APS, 50 rheumatoid arthritis, 16 Sjögren’s syndrome, 21 systemic sclerosis, 10 polymyositis/ dermatomyositis and 56 other autoimmune diseases

Sciascia et al.

 

2015

Retrospective

To evaluate the clinical relevance of the global APS score (GAPSS) in a cohort of primary APS patients

62

PAPS patients

Zigon et al.

 

2016

Retrospective

To evaluate association of different risk factors with thrombosis; and b) to apply GAPSS on a large cohort of unselected Slovenian patients

585

 Systemic Autoimmune Diseases

Sciascia et al.

 

2016

Retrospective

To evaluate the clinical utility of the GAPSS with the help of APS ACTION Registry

550

APS Patients

Zu et al.

 

2016

Retrospective

To evaluate the clinical revalence of aGAPSS in a chinese cohort

89

89 APS Patients

Fernandez Mosteirin et al.

 

2017

Retrospective

To independently validate the aGAPSS to predict thrombosis in a cohort of patients with APS and/or autoimmune disease

319

PAPS diagnosed in 130 patients and 89 SAPS patients, and 100 patients with autoimmune disease without APS

Radin et al.

 

2017

Retrospective

To investigate the validity of aGAPSS in young patients with myocardial infarction

83

APS Patients

 

 

 

 

 

 

 

 

 

 

 

 

Table 2. GAPSS and aGAPSS between groups

Sciascia et al. 2013

Sciascia et al. 2014

Zuily et al. 2015

Oku et al. 2015

Sciascia et al. 2015

Sciascia et al. 2016

CUMULATIVE GAPSS mean(±SD)

Zu et al. 2016

Radin et al. 2017

Fernandez Mosteirin et al. 2017

CUMULATIVE aGAPPS mean(±SD)

Total N

105

51

137

282

62

550

1187

98

83

319

500

Thrombotic N

37

4

16

N/A

39

N/A

96

53

70

201

324

GAPSS mean(± SD)

9.6 (4.8)

10 (5.4)

10.88 (5.06)

N/A

11.5 (4.6)

N/A

10.6 (4.74)

9.4 (3.2)

9.2 (5.1)

6.58 (3.36)

7.6 (3.95)

Non Thrombotic N

68

47

121

N/A

N/A

N/A

236

N/A

N/A

118

118

GAPSS mean(±SD)

4.9 (5)

7.13 (5.75)

8.15 (5.31)

N/A

N/A

N/A

7.01 (5.46)

N/A

N/A

4.9 (4.33)

4.9 (4.33)

PM N

22

N/A

N/A

11

44

419

496

38

N/A

N/A

38

GAPSS mean(±SD)

7.3 (5)

N/A

N/A

4

8.7 (3.2)

9

8.78

6.7 (2.8)

N/A

N/A

6.7 (2.8)

 

Graph 1. Cumulative GAPSS values between groups

 

Disclosure: S. Sciascia, None; M. Radin, None; G. Sanna, None; I. Cecchi, None; D. Roccatello, None; M. L. Bertolaccini, None.

To cite this abstract in AMA style:

Sciascia S, Radin M, Sanna G, Cecchi I, Roccatello D, Bertolaccini ML. Clinical Utility of the Global Antiphospholipid Syndrome Score (GAPSS) for Risk Stratification: A Pooled Analysisfrom 2273 Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/clinical-utility-of-the-global-antiphospholipid-syndrome-score-gapss-for-risk-stratification-a-pooled-analysisfrom-2273-patients/. Accessed August 21, 2018.

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