A diagnostic score for molecular analysis of hereditary autoinflammatory syndromes with periodic fever in children.
OBJECTIVE
To identify a set of clinical parameters that can predict the probability of carrying mutations in one of the genes associated with hereditary autoinflammatory syndromes.


METHODS
A total of 228 consecutive patients with a clinical history of periodic fever were screened for mutations in the MVK, TNFRSF1A, and MEFV genes, and detailed clinical information was collected. A diagnostic score was formulated based on univariate and multivariate analyses in genetically positive and negative patients (training set). The diagnostic score was validated in an independent set of 77 patients (validation set).


RESULTS
Young age at onset (odds ratio [OR] 0.94, P = 0.003), positive family history of periodic fever (OR 4.1, P = 0.039), thoracic pain (OR 4.6, P = 0.05), abdominal pain (OR 33.1, P < 0.001), diarrhea (OR 3.3, P = 0.028), and oral aphthosis (OR 0.2, P = 0.007) were found to be independently correlated with a positive genetic test result. These variables were combined in a linear score whose ability to predict a positive result on genetic testing was validated in an independent data set. In this latter set, the diagnostic score revealed high sensitivity (82%) and specificity (72%) for discriminating patients who were genetically positive from those who were negative. In patients with a high probability of having a positive result on genetic testing, a regression tree analysis provided the most reasonable order in which the genes should be screened.


CONCLUSIONS
The proposed approach in patients with periodic fever will increase the probability of obtaining positive results on genetic testing, with good specificity and sensitivity. Our results further help to optimize the molecular analysis by suggesting the order in which the genes should be screened.
Gattorno
M
M
Giannina Gaslini Institute, Genoa, Italy.
Sormani
M P
MP
D'Osualdo
A
A
Pelagatti
M A
MA
Caroli
F
F
Federici
S
S
Cecconi
M
M
Solari
N
N
Meini
A
A
Zulian
F
F
Obici
L
L
Breda
L
L
Martino
S
S
Tommasini
A
A
Bossi
G
G
Govers
A
A
Touitou
I
I
Woo
P
P
Frenkel
J
J
Koné-Paut
I
I
Baldi
M
M
Ceccherini
I
I
Martini
A
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003598:Cytoskeletal Proteins / Q000235:genetics; D003967:Diarrhea / Q000209:etiology; D010505:Familial Mediterranean Fever / Q000175:diagnosis* / Q000235:genetics*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D017853:Phosphotransferases (Alcohol Group Acceptor) / Q000235:genetics; D000071198:Pyrin; D047888:Receptors, Tumor Necrosis Factor, Type I / Q000235:genetics; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013281:Stomatitis, Aphthous / Q000209:etiology
D003598:Cytoskeletal Proteins; C000604192:MEFV protein, human; D000071198:Pyrin; D047888:Receptors, Tumor Necrosis Factor, Type I; C506235:TNFRSF1A protein, human; D017853:Phosphotransferases (Alcohol Group Acceptor); C021796:mevalonate kinase