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临床风险评分在识别系统性红斑狼疮患者基于血管超声的高心血管风险方面表现不佳。

Underperformance of clinical risk scores in identifying vascular ultrasound-based high cardiovascular risk in systemic lupus erythematosus.

机构信息

Cardiovascular Risk Research Laboratory, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Greece.

Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Greece.

出版信息

Eur J Prev Cardiol. 2021 Apr 23;28(3):346-352. doi: 10.1093/eurjpc/zwaa256.

DOI:10.1093/eurjpc/zwaa256

PMID:33891687

Abstract

AIMS

The aim of this study was to assess the performance of eight clinical risk prediction scores to identify individuals with systemic lupus erythematosus (SLE) at high cardiovascular disease (CVD) risk, as defined by the presence of atherosclerotic plaques.

METHODS

CVD risk was estimated in 210 eligible SLE patients without prior CVD or diabetes mellitus (female: 93.3%, mean age: 44.8 ± 12 years) using five generic (Systematic Coronary Risk Evaluation (SCORE), Framingham Risk Score (FRS), Pooled Cohort Risk Equations (ASCVD), Globorisk, Prospective Cardiovascular Münster Study risk calculator (PROCAM)) and three 'SLE-adapted' (modified-SCORE, modified-FRS, QRESEARCH risk estimator, version 3 (QRISK3)) CVD risk scores, as well as ultrasound examination of the carotid and femoral arteries. Calibration, discrimination and classification measures to identify high CVD risk based on the presence of atherosclerotic plaques were assessed for all risk models. CVD risk reclassification was applied for all scores by incorporating ultrasound results.

RESULTS

Moderate calibration (p-value range from 0.38 to 0.63) and discrimination (area under the curve 0.73-0.84), and low-to-moderate sensitivity (8.3-71.4%) and classification ability (Matthews correlation coefficient (MCC) 0.25-0.47) were observed for all risk models to identify patients with plaques at any arterial site as high-risk. MCC was improved for modified-FRS versus FRS (0.43 vs 0.36), but not for modified-SCORE versus SCORE (0.25 vs 0.25). Based on plaque presence, CVD risk was upgraded to high-risk in 10%, 16.1%, 20.5%, 21.5%, 24%, 28.2% and 28.6% of cases classified as non-high-risk by QRISK3, modified-FRS, Globorisk, FRS/PROCAM, ASCVD, modified-SCORE and SCORE, respectively.

CONCLUSIONS

Most of the five generic and three 'SLE-adapted' clinical risk scores underestimated high CVD risk defined by atherosclerotic plaque presence in patients with SLE.

摘要

目的

本研究旨在评估八项临床风险预测评分在识别系统性红斑狼疮（SLE）患者中的表现，这些患者具有心血管疾病（CVD）高风险，其定义为存在动脉粥样硬化斑块。

方法

在 210 名无先前 CVD 或糖尿病的合格 SLE 患者中（女性：93.3%，平均年龄：44.8±12 岁），使用五种通用（系统性冠状动脉风险评估（SCORE）、弗雷明汉风险评分（FRS）、 pooled Cohort Risk Equations（ASCVD）、Globorisk、前瞻性心血管慕尼黑研究风险计算器（PROCAM））和三种“SLE 适应性”（改良-SCORE、改良-FRS、QRESEARCH 风险估计器，版本 3（QRISK3））CVD 风险评分来估计 CVD 风险，并对颈动脉和股动脉进行超声检查。评估了所有风险模型在基于动脉粥样硬化斑块存在的情况下识别 CVD 高风险的校准、区分和分类措施。将所有评分的 CVD 风险重新分类，纳入超声结果。

结果

所有风险模型在识别任何动脉部位斑块患者为高风险时，均表现出中等校准（p 值范围为 0.38 至 0.63）和中等区分（曲线下面积为 0.73 至 0.84），以及低至中等敏感性（8.3%至 71.4%）和分类能力（马修斯相关系数（MCC）为 0.25 至 0.47）。与 FRS 相比，改良-FRS 对改良-SCORE 的 MCC 有所提高（0.43 对 0.36），但与 SCORE 相比则没有提高（0.25 对 0.25）。基于斑块的存在，QRISK3、改良-FRS、Globorisk、FRS/PROCAM、ASCVD、改良-SCORE 和 SCORE 分别将非高危患者中 CVD 风险升级为高危的比例为 10%、16.1%、20.5%、21.5%、24%、28.2%和 28.6%。