Comparison of the classification criteria for antiphospholipid syndrome (APS) of ACR/EULAR 2023 vs. Sidney criteria 2006 in a sample of pregnant women with APS

Abstract

Introduction

Antiphospholipid antibody syndrome (APS) is characterized by the presence of thrombosis and obstetric pathology.

Objective

To analyze the diagnostic validity of the APS classification criteria published in 2023 by the American College of Rheumatology (ACR) together with the European Alliance of Associations for Rheumatology (EULAR) and to compare them with the 2006 Sydney criteria in pregnant women with suspected APS.

Material and methods

Retrospective observational cohort study based on the follow-up of 754 pregnancies by the Autoimmune Diseases Unit of the Miguel Servet University Hospital in Zaragoza. The diagnosis of its specialist doctors was considered to be gold-standard. Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) were calculated for the Sydney and ACR/ELAR criteria, with a value of P < .05.

Results

The 2023 ACR/EULAR classification criteria had a sensitivity of 17.47% (AUC 0.583) compared to 74.70% (AUC 0.871) for the Sydney criteria.

Discussion

The new ACR/EULAR 2023 criteria are more complex due to the incorporation of new evidence in antiphospholipid syndrome; However, in terms of results, we found a clearly lower sensitivity in the new criteria in agreement with the findings of other studies.

Conclusions

The diagnosis of APS continues to be a challenge, due to its multifactorial nature, high prevalence of thrombosis and pregnancy morbidity in the population, broad range of antiphospholipid antibody and the absence of a gold-standard. The results of our study suggest a worse diagnostic performance of the ACR/EULAR criteria compared to the Sydney criteria for the classification of obstetric APS, so further studies are needed to confirm these findings.