Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2022 Jul 29:13:930087.
doi: 10.3389/fimmu.2022.930087. eCollection 2022.

A novel aGAPSS-based nomogram for the prediction of ischemic stroke in patients with antiphospholipid syndrome

Xiaodong Song  1 , Yangyi Fan  1 , Yuan Jia  2 , Gongming Li  3 , Meige Liu  1 , Yicheng Xu  4 , Jun Zhang  1 , Chun Li  2
Affiliations
Randomized Controlled Trial

A novel aGAPSS-based nomogram for the prediction of ischemic stroke in patients with antiphospholipid syndrome

Xiaodong Song et al. Front Immunol. .

Abstract

Background: Ischemic stroke (IS) is the most common and life-threatening arterial manifestation of antiphospholipid syndrome (APS). It is related to high mortality and severe permanent disability in survivors. Thus, it is essential to identify patients with APS at high risk of IS and adopt individual-level preventive measures. This study was conducted to identify risk factors for IS in patients with APS and to develop a nomogram specifically for IS prediction in these patients by combining the adjusted Global Anti-Phospholipid Syndrome Score (aGAPSS) with additional clinical and laboratory data.

Methods: A total of 478 consecutive patients with APS were enrolled retrospectively. All patients were randomly assigned to the training and validation cohorts. Univariate and multivariate binary logistic analyses were conducted to identify predictors of IS in the training cohort. Then, a nomogram was developed based on these predictors. The predictive performance of the nomogram for the training and validation cohorts was evaluated by determining areas under the receiver operating characteristic curve (AUROC) and creating calibration plots. A decision curve analysis (DCA) was conducted to compare the potential net benefits of the nomogram with those of the aGAPSS.

Results: During a mean follow-up period of 2.7 years, 26.9% (129/478) of the patients were diagnosed with IS. Binary logistic regression analysis revealed that five risk factors were independent clinical predictors of IS: age (P < 0.001), diabetes (P = 0.030), hyperuricemia (P < 0.001), the platelet count (P = 0.001), and the aGAPSS (P = 0.001). These predictors were incorporated into the nomogram, named the aGAPSS-IS. The nomogram showed satisfactory performance in the training [AUROC = 0.853 (95% CI, 0.802-0.896] and validation [AUROC = 0.793 (95% CI, 0.737-0.843)] cohorts. Calibration curves showed good concordance between observed and nomogram-predicted probability in the training and validation cohorts. The DCA confirmed that the aGAPSS-IS provided more net benefits than the aGAPSS in both cohorts.

Conclusion: Age, diabetes, hyperuricemia, the platelet count, and the aGAPSS were risk factors for IS in patients with APS. The aGAPSS-IS may be a good tool for IS risk stratification for patients with APS based on routinely available data.

Keywords: adjusted Global Anti-Phospholipid Syndrome Score; antiphospholipid syndrome; ischemic stroke; nomogram; risk stratification.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow diagram. IS, ischemic stroke; APS, antiphospholipid antibody syndrome.
Figure 2
Figure 2
The nomogram for predicting the risk of IS in the training cohort. For each patient, we added up the points identified on the points scale for the five risk factors. Then, the risk probability of IS was obtained according to the “Total Points” axis of the nomogram. APS, antiphospholipid syndrome; IS, ischemic stroke; aGAPSS, adjusted Global Anti-Phospholipid Syndrome Score; PLT, platelet count.
Figure 3
Figure 3
Comparison of the area under the receiver operating characteristic curve values between aGAPSS-IS score and aGAPSS in the training and the validation cohort. (A) In the training cohort, the aGAPSS-IS score had a larger AUROC than the aGAPSS [0.853 (95% CI, 0.802-0.896) vs. 0.686 (95% CI, 0.623-0.744), P < 0.001]; (B) In the validation cohort, the AUROC of aGAPSS-IS score was larger than the aGAPSS [0.793 (95% CI, 0.737-0.843) vs. 0.624 (95% CI, 0.560-0.656), P < 0.001]. aGAPSS, adjusted Global Anti-Phospholipid Syndrome Score.
Figure 4
Figure 4
The calibration curve of the aGAPSS-IS score in the training and the validation cohort. (A) mean absolute error = 0.015 (training cohort); (B) mean absolute error = 0.028 (validation cohort).
Figure 5
Figure 5
Comparison of the decision curves between the aGAPSS-IS score and aGAPSS in the training and the validation cohort. (A) For a threshold probability > 2%, application of the aGAPSS-IS score would add more net benefit to patients compared to the use of the aGAPSS in the training cohort. (B) For a threshold probability > 4%, the aGAPSS-IS score would provide more net benefit to APS patients than the aGAPSS in the validation cohort. aGAPSS adjusted Global Anti-Phospholipid Syndrome Score.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. . International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost (2006) 4(2):295–306. doi: 10.1111/j.1538-7836.2006.01753.x - DOI - PubMed
    1. Muscal E, Brey RL. Neurologic manifestations of the antiphospholipid syndrome: integrating molecular and clinical lessons. Curr Rheumatol Rep (2008) 10(1):67–73. doi: 10.1007/s11926-008-0012-y - DOI - PubMed
    1. Cervera R, Piette JC, Font J, Khamashta MA, Cervera R, Piette JC, et al. . Antiphospholipid syndrome - clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheumatol (2002) 46(4):1019–27. doi: 10.1002/art.10187 - DOI - PubMed
    1. Asherson RA, Khamashta MA, Ordiros J, Derksen R, Machin SJ, Barquinero J, et al. . The primary antiphospholipid syndrome - major clinical and serological features. Med (Baltimore) (1989) 68(6):366–74. doi: 10.1097/00005792-198911000-00004 - DOI - PubMed
    1. Sciascia S, Sanna G, Khamashta MA, Cuadrado MJ, Erkan D, Andreoli L, et al. . The estimated frequency of antiphospholipid antibodies in young adults with cerebrovascular events: a systematic review. Ann Rheum Dis (2015) 74(11):2028–33. doi: 10.1136/annrheumdis-2014-205663 - DOI - PubMed

Publication types