Prediction risk chart for scleroderma digital ulcers: a composite predictive model based on capillaroscopic, demographic and clinico-serological parameters.
BACKGROUND
Digital ulcers (DU) affect 50% of systemic sclerosis (SSc) patients, representing a challenging clinical problem. Despite a high negative predictive value, capillaroscopic scores proposed to select patients at risk for DU show an inadequate positive predictive value, especially in patients without previous DU.


OBJECTIVE
To increase the predictive value for DU development of capillaroscopy, through a predictive risk chart taking into account capillaroscopic, demographic, and clinico-serological parameters.


METHODS
Two hundred and nineteen unselected SSc patients from 8 Italian Rheumatology Centers were consecutively enrolled during a 6-month period. Demographic, clinical, serological and instrumental data and capillaroscopy skin ulcers risk index (CSURI) were collected.


RESULTS
A multivariate logistic regression analysis showed a significant positive association between DU appearance and male gender, DU history, altered CSURI, and ESR. A prediction risk chart of the development of DU within 6 months were built on the basis of the above parameters. According to the risk level, four risk classes were identified: low (≤19.3%); medium (>19.3%, ≤58.6%); high (>58.6%, ≤89.2%), and very high risk (>89.2%).


CONCLUSIONS
The systematic evaluation of the above parameters can be helpful to identify patients at risk to develop DU optimizing preventive vasoactive therapy.
Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
Andreina
A
Manfredi
Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
Marco
M
Sebastiani
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy.
Valeria
V
Carraro
Department of Clinical and Experimental Medicine, Rheumatology Unit, Second University of Naples, Naples, Italy.
Michele
M
Iudici
Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.
Mario
M
Bocci
Department of Internal Medicine, Rheumatology Unit, Policlinico S. Orsola Malpighi, Bologna, Italy.
Gentiana
G
Vukatana
Rheumatology Unit, Department of Clinical & Experimental Medicine, University of Perugia, Perugia, Italy.
Roberto
R
Gerli
Rheumatology Unit, Department of Molecular Pathology and Innovative Therapies, Università Politecnica delle Marche, Ancona, Italy.
Rossella
R
De Angelis
Internal Medicine Unit - Civitanova Marche Hospital, Italy.
Patrizia
P
Del Medico
DiMIMP, Rheumatology Unit, University of Bari, Bari, Italy.
Emanuela
E
Praino
Department of Clinical and Experimental Medicine-Rheumatology Unit, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy.
Andrea
A
Lo Monaco
Unit of Statistics in Medicine, Department of Public Health, Clinical and Diagnostic Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Roberto
R
D'Amico
Unit of Statistics in Medicine, Department of Public Health, Clinical and Diagnostic Medicine, University of Modena and Reggio Emilia, Modena, Italy.
Cinzia
C
Del Giovane
Department of Internal Medicine, Pugliese-Ciaccio Hospital, Catanzaro, Italy.
Salvatore
S
Mazzuca
Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
Michele
M
Colaci
Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
Dilia
D
Giuggioli
Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
Clodoveo
C
Ferri
D005260:Female; D005385:Fingers; D006801:Humans; D008297:Male; D020678:Microscopic Angioscopy / Q000379:methods*; D008875:Middle Aged; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications*; D014456:Ulcer
capillaroscopy; digital ulcers; predictive risk chart; systemic sclerosis