Internal Medicine Department, University of Algiers 1, Faculty of Medical Sciences, Benyoucef Benkhedda, Bab El Oued University Hospital Center, 16000, Bab El Oued City, Algiers, Algeria.
Biochemistry, Hemotology and Genetics Laboratory of Research, Bab El Oued University Hospital Center, Bab El Oued City, Algiers, Algeria.
Clin Rheumatol. 2023 Apr;42(4):1125-1135. doi: 10.1007/s10067-023-06509-8. Epub 2023 Jan 25.
This study was performed to develop a new diagnostic algorithm for adult-onset Still's disease (AOSD).
We conducted a multicenter prospective nationwide case-control study in tertiary Internal Medicine, Rheumatology, and Infectious Diseases departments, to include successively patients with suspected AOSD based on the presence of two or more major criteria of Yamaguchi and/or Fautrel classifications. Patients were classified as AOSD or controls according to a predefined procedure. A receiving operating characteristic curve was used to determine the best cutoff value of the points-based score for disease classification. A diagnostic algorithm was developed to help the physician in the diagnostic approach.
A total of 160 patients were included, 80 patients with AOSD and 60 controls with different diagnoses. Twenty patients with incomplete data were excluded. In the multivariate analysis, 6 items remained independently associated with AOSD diagnosis: typical rash (OR: 24.01, 3 points), fever ≥ 39 °C (OR: 17.34, 3 points), pharyngitis (OR: 10.23, 2 points), arthritis (OR: 9.01, 2 points), NLR ≥ 4 (OR: 11.10, 2 points), and glycosylated ferritin ≤ 20% (OR: 1.59, 1 point). AOSD should be considered if the patient satisfies 7 points with a sensitivity of 92.5%, specificity of 93.3%, and accuracy of 92.8% (area under the curve (AUC): 0.97 [95% CI: 0.94-0.99]). The present points-based score was more accurate and sensitive than the Yamaguchi classification (78.8%, 92.5%, p = 0.01) and Fautrel classification (76.3%, 92.5%, p = 0.004). A typical rash associated with a points-based score ≥ 7 points leads to a very likely disease.
The proposed new algorithm could be a good diagnostic tool for adult-onset Still's disease in clinical practice and research. Key Points • A diagnostic algorithm was performed to help the physician in the diagnostic approach of AOSD. • The points-based score included in this algorithm had a high sensitivity and accuracy. • This diagnostic algorithm can be useful in the clinical research.
本研究旨在开发一种新的成人Still 病（AOSD）诊断算法。
我们在三级内科、风湿病学和传染病学部门进行了一项多中心前瞻性全国病例对照研究，根据 Yamaguchi 和/或 Fautrel 分类的两个或更多主要标准，对疑似 AOSD 的患者进行连续纳入。根据预先确定的程序，患者被归类为 AOSD 或对照组。使用接收者操作特征曲线确定基于点的评分用于疾病分类的最佳截断值。开发了一种诊断算法来帮助医生进行诊断方法。
共纳入 160 例患者，80 例 AOSD 患者和 60 例不同诊断的对照组。20 例数据不完整的患者被排除在外。在多变量分析中，有 6 个项目与 AOSD 诊断独立相关：典型皮疹（OR：24.01，3 分）、发热≥39°C（OR：17.34，3 分）、咽炎（OR：10.23，2 分）、关节炎（OR：9.01，2 分）、NLR≥4（OR：11.10，2 分）和糖化铁蛋白≤20%（OR：1.59，1 分）。如果患者满足 7 分，具有 92.5%的敏感性、93.3%的特异性和 92.8%的准确性（曲线下面积（AUC）：0.97 [95%CI：0.94-0.99]），则应考虑 AOSD。与 Yamaguchi 分类（78.8%，92.5%，p=0.01）和 Fautrel 分类（76.3%，92.5%，p=0.004）相比，本点评分更准确和敏感。伴有≥7 分的典型皮疹提示极有可能发生疾病。
提出的新算法可以成为临床实践和研究中成人Still 病的良好诊断工具。关键点• 提出了一种诊断算法来帮助医生进行 AOSD 的诊断方法。• 包含在该算法中的基于点的评分具有高敏感性和准确性。• 该诊断算法在临床研究中可能有用。
