Yasaman Ahmadzadeh, Larry S Magder, Danieli Castro Oliveira de Andrade, Diana Paredes-Ruiz, Maria G Tektonidou, Vittorio Pengo, Savino Sciascia, Laura Andreoli, Flávio Signorelli, Paul R Fortin, Maria Efthymiou, H Michael Belmont, Giuseppe Barilaro, Ann E Clarke, Tatsuya Atsumi, Chary López-Pedrera, Jason S Knight, D Ware Branch, Rohan Willis, Nina Kello, Zhuoli Zhang, Esther Rodriguez Almaraz, Bahar Artim-Esen, Jose Pardos-Gea, Guillermo Pons-Estel, Giulia Pazzola, Hui Shi, Alí Duarte-García, Jonathan Thaler, Megan R W Barber, Leslie Skeith, Massimo Radin, Pier Luigi Meroni, Robert Roubey, Maria Laura Bertolaccini, Hannah Cohen, Michelle Petri, Doruk Erkan
{"title":"抗磷脂抗体阳性患者死亡率的预测因素：来自抗磷脂综合征联盟临床试验和国际网络（APS ACTION）临床数据库和存储库（“Registry”）的前瞻性结果","authors":"Yasaman Ahmadzadeh, Larry S Magder, Danieli Castro Oliveira de Andrade, Diana Paredes-Ruiz, Maria G Tektonidou, Vittorio Pengo, Savino Sciascia, Laura Andreoli, Flávio Signorelli, Paul R Fortin, Maria Efthymiou, H Michael Belmont, Giuseppe Barilaro, Ann E Clarke, Tatsuya Atsumi, Chary López-Pedrera, Jason S Knight, D Ware Branch, Rohan Willis, Nina Kello, Zhuoli Zhang, Esther Rodriguez Almaraz, Bahar Artim-Esen, Jose Pardos-Gea, Guillermo Pons-Estel, Giulia Pazzola, Hui Shi, Alí Duarte-García, Jonathan Thaler, Megan R W Barber, Leslie Skeith, Massimo Radin, Pier Luigi Meroni, Robert Roubey, Maria Laura Bertolaccini, Hannah Cohen, Michelle Petri, Doruk Erkan","doi":"10.1002/acr.25503","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The objective was to determine the mortality rate as well as the causes and predictors of death in antiphospholipid antibody (aPL)-positive patients with and without antiphospholipid syndrome (APS) classification.</p><p><strong>Methods: </strong>The inclusion criterion for the multicenter international Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) registry is positive aPLs according to the Revised Sapporo Classification Criteria tested within one year before enrollment. Patients are observed every 12 ± 3 months with clinical data and blood collection. For this prospective analysis, we first analyzed the causes of death for patients reported as \"deceased.\" Secondly, we analyzed risk factors for death using the adjusted Cox proportional hazards model and calculated survival probability using the Kaplan-Meier model based on different age groups.</p><p><strong>Results: </strong>Of 967 patients, 43 (5%) were deceased after a median follow-up of 5.3 years. Based on the univariate analysis, deceased patients, compared to living patients, were more likely to be older and have a history of arterial thrombosis, catastrophic APS, concomitant systemic autoimmune diseases (SAIDs), and baseline cardiovascular disease (CVD) risk factors. Based on the Cox proportional hazards model adjusted for age and for each of the strongest predictors of death, arterial thrombosis (hazard ratio [HR] 2.94, 95% confidence interval [CI] 1.50-5.76), concomitant SAIDs (HR 2.97, 95% 1.56-5.63), and baseline any CVD risk factor (HR 2.43, 95% CI 1.05-5.71) were significantly associated with mortality.</p><p><strong>Conclusion: </strong>In our cohort of persistently aPL-positive patients, the mortality rate was 5% after a median follow-up of five years and was highest for patients >60 years old at registry entry. History of arterial thrombosis, concomitant SAIDs, and baseline any CVD risk factor independently predicted future death.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictors of Mortality in Antiphospholipid Antibody-Positive Patients: Prospective Results From Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking Clinical Database and Repository.\",\"authors\":\"Yasaman Ahmadzadeh, Larry S Magder, Danieli Castro Oliveira de Andrade, Diana Paredes-Ruiz, Maria G Tektonidou, Vittorio Pengo, Savino Sciascia, Laura Andreoli, Flávio Signorelli, Paul R Fortin, Maria Efthymiou, H Michael Belmont, Giuseppe Barilaro, Ann E Clarke, Tatsuya Atsumi, Chary López-Pedrera, Jason S Knight, D Ware Branch, Rohan Willis, Nina Kello, Zhuoli Zhang, Esther Rodriguez Almaraz, Bahar Artim-Esen, Jose Pardos-Gea, Guillermo Pons-Estel, Giulia Pazzola, Hui Shi, Alí Duarte-García, Jonathan Thaler, Megan R W Barber, Leslie Skeith, Massimo Radin, Pier Luigi Meroni, Robert Roubey, Maria Laura Bertolaccini, Hannah Cohen, Michelle Petri, Doruk Erkan\",\"doi\":\"10.1002/acr.25503\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The objective was to determine the mortality rate as well as the causes and predictors of death in antiphospholipid antibody (aPL)-positive patients with and without antiphospholipid syndrome (APS) classification.</p><p><strong>Methods: </strong>The inclusion criterion for the multicenter international Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) registry is positive aPLs according to the Revised Sapporo Classification Criteria tested within one year before enrollment. Patients are observed every 12 ± 3 months with clinical data and blood collection. For this prospective analysis, we first analyzed the causes of death for patients reported as \\\"deceased.\\\" Secondly, we analyzed risk factors for death using the adjusted Cox proportional hazards model and calculated survival probability using the Kaplan-Meier model based on different age groups.</p><p><strong>Results: </strong>Of 967 patients, 43 (5%) were deceased after a median follow-up of 5.3 years. Based on the univariate analysis, deceased patients, compared to living patients, were more likely to be older and have a history of arterial thrombosis, catastrophic APS, concomitant systemic autoimmune diseases (SAIDs), and baseline cardiovascular disease (CVD) risk factors. Based on the Cox proportional hazards model adjusted for age and for each of the strongest predictors of death, arterial thrombosis (hazard ratio [HR] 2.94, 95% confidence interval [CI] 1.50-5.76), concomitant SAIDs (HR 2.97, 95% 1.56-5.63), and baseline any CVD risk factor (HR 2.43, 95% CI 1.05-5.71) were significantly associated with mortality.</p><p><strong>Conclusion: </strong>In our cohort of persistently aPL-positive patients, the mortality rate was 5% after a median follow-up of five years and was highest for patients >60 years old at registry entry. 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引用次数: 0
摘要
目的：目的是确定有/无APS分类的抗磷脂抗体（aPL）阳性患者的死亡率以及死亡率的原因和预测因素。方法：多中心国际APS ACTION注册中心的纳入标准为入组前1年内按照修订的札幌分类标准检测的阳性aPL。每12±3个月随访一次，收集临床资料和血液。对于这一前瞻性分析，我们首先分析了报告为“死亡”的患者的死亡原因。其次，采用调整后的Cox比例风险模型分析死亡率的危险因素，并采用Kaplan-Meier模型计算不同年龄组的生存率。结果：967例患者中，43例（5%）在中位5.3年随访后死亡。基于单因素分析，与未死亡的患者相比，死亡患者更有可能年龄较大，并有动脉血栓形成史、灾难性APS （CAPS）、伴随的系统性自身免疫性疾病（SAIDx）和基线心血管疾病（CVD）危险因素。根据年龄校正的cox比例风险模型和死亡率的每个最强预测因子，动脉血栓形成（HR 2.94, 95% CI 1.50-5.76）、合并SAIDx （HR 2.97, 95% 1.56-5.63）和基线任何心血管疾病危险因素（HR 2.43, 95% CI 1.05-5.71）与死亡率显著相关。结论：在我们的持续apl阳性患者队列中，中位随访5年后死亡率为5%，在登记时超过60岁的患者死亡率最高。动脉血栓形成史、伴发SAIDx和基线任何CVD危险因素独立预测未来死亡率。
Predictors of Mortality in Antiphospholipid Antibody-Positive Patients: Prospective Results From Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking Clinical Database and Repository.
Objective: The objective was to determine the mortality rate as well as the causes and predictors of death in antiphospholipid antibody (aPL)-positive patients with and without antiphospholipid syndrome (APS) classification.
Methods: The inclusion criterion for the multicenter international Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) registry is positive aPLs according to the Revised Sapporo Classification Criteria tested within one year before enrollment. Patients are observed every 12 ± 3 months with clinical data and blood collection. For this prospective analysis, we first analyzed the causes of death for patients reported as "deceased." Secondly, we analyzed risk factors for death using the adjusted Cox proportional hazards model and calculated survival probability using the Kaplan-Meier model based on different age groups.
Results: Of 967 patients, 43 (5%) were deceased after a median follow-up of 5.3 years. Based on the univariate analysis, deceased patients, compared to living patients, were more likely to be older and have a history of arterial thrombosis, catastrophic APS, concomitant systemic autoimmune diseases (SAIDs), and baseline cardiovascular disease (CVD) risk factors. Based on the Cox proportional hazards model adjusted for age and for each of the strongest predictors of death, arterial thrombosis (hazard ratio [HR] 2.94, 95% confidence interval [CI] 1.50-5.76), concomitant SAIDs (HR 2.97, 95% 1.56-5.63), and baseline any CVD risk factor (HR 2.43, 95% CI 1.05-5.71) were significantly associated with mortality.
Conclusion: In our cohort of persistently aPL-positive patients, the mortality rate was 5% after a median follow-up of five years and was highest for patients >60 years old at registry entry. History of arterial thrombosis, concomitant SAIDs, and baseline any CVD risk factor independently predicted future death.
期刊介绍：
Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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