title: GAPSS: the Global Anti-Phospholipid Syndrome Score.
abstract: OBJECTIVE
  To develop and validate a risk score [global APS score (GAPSS)] derived from the combination of independent risk for thrombosis and pregnancy loss (PL), taking into account the aPL profile, conventional cardiovascular risk factors and the autoimmune antibody profile.
  
  
  METHODS
  This cross-sectional study included 211 consecutive SLE patients. Data on clinical manifestations, conventional cardiovascular risk factors, aPL profile, ANAs, ENA and anti-dsDNA were collected. Long-term low-dose aspirin, oral anticoagulant and HCQ treatment were also included in the analysis. Patients were randomly divided into two sets by a computer-generated randomized list. We developed GAPSS in the first set of patients (n = 106), assigning the risk factors identified by multivariate analysis weighted points proportional to the β-regression coefficient values. GAPSS was validated in the second set of patients (n = 105). The relationship between GAPPS and thrombosis and/or PL was analysed.
  
  
  RESULTS
  In the first set, higher values of GAPSS were seen in patients who experienced thrombosis and/or PL compared with those without clinical events [GAPSS 9.3 (4.8) (range 1-19) and 5.3 (4) (range 0-16), P < 0.001]. Also taken separately, patients who experienced thrombosis or PL showed higher GAPSS compared with those without clinical events [GAPSS 9.6 (4.8) (range 1-19) vs 4.9 (5) (range 0-14), P = 0.027 for thrombosis; 7.3 (5) vs 3.9 (5.1) (range 0-16), P = 0.024 for PL, respectively]. In the second set, the results were similar, with statistically higher values of GAPSS in patients with a clinical history of thrombosis and/or PL compared with those without events [GAPSS 9.5 (5.6) (range 0-20) and 3.9 (4.1) (range 0-17), P < 0.001). Higher values were also seen when subclassifying the patients according to the clinical manifestation, thrombosis or PL [GAPSS 9.5 (5.6) (range 0-20) vs 4.8 (5.4) (range 0-17), P = 0.036 for thrombosis; 7.9 (3.3) vs 3.8 (5.4) (range 0-16), P = 0.037 for PL, respectively).
  
  
  CONCLUSIONS
  These data propose a substantial improvement in risk prediction of thrombosis or PL in SLE based on assessment of the GAPSS, a quantitative scoring system.
authors: Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, London SE1 7EH, UK.
authors: Savino
authors: S
authors: Sciascia
authors: Giovanni
authors: G
authors: Sanna
authors: Veronica
authors: V
authors: Murru
authors: Dario
authors: D
authors: Roccatello
authors: Munther A
authors: MA
authors: Khamashta
authors: Maria Laura
authors: ML
authors: Bertolaccini
mesh_terms: D000022:Abortion, Spontaneous / Q000175:diagnosis / Q000276:immunology*; D000328:Adult; D000704:Analysis of Variance; D017152:Antibodies, Antiphospholipid / Q000276:immunology*; D016736:Antiphospholipid Syndrome / Q000175:diagnosis*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000276:immunology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis*; D008875:Middle Aged; D015999:Multivariate Analysis; D011247:Pregnancy; D011516:Prothrombin / Q000378:metabolism; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013927:Thrombosis / Q000175:diagnosis* / Q000276:immunology; D006113:United Kingdom
chemical_list: D017152:Antibodies, Antiphospholipid; D011516:Prothrombin
keywords: Hughes syndrome; antiphospholipid antibodies; pregnancy loss; prothrombin; thrombosis