Daoud Mathieu, Suppa Mariano, Benhadou Farida, Daxhelet Mathilde, Njimi Hassane, White Jonathan, Jemec Gregor, Del Marmol Véronique
Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.
Front Med (Lausanne). 2023 Apr 17;10:1145152. doi: 10.3389/fmed.2023.1145152. eCollection 2023.
Partly due to its clinical heterogeneity, hidradenitis suppurativa (HS) is difficult to score accurately; illustrated by the large number of disease scores. In 2016, a systematic review by Ingram et al. reported the use of about thirty scores, and since then, this number has increased further. Our aim is twofold: to provide a succinct but detailed narrative review of the scores used to date, and to compare these scores with each other for individual patients.
The review of the literature was done among articles in English and French, on Google, Google scholar, Pubmed, ScienceDirect and Cochrane. To illustrate the differences between scores, data from some Belgian patients included in the European Registry for HS were selected. A first series of patients compares the severity of the following scores: Hurley, Hurley Staging refined, three versions of Sartorius score (2003, 2007, 2009), Hidradenitis Suppurativa Physician Global Assessment (HS-PGA), International Hidradenitis Suppurativa Severity Scoring System (IHS4), Severity Assessment of Hidradenitis Suppurativa (SAHS), Hidradenitis Suppurativa Severity Index (HSSI), Acne Inversa Severity Index (AISI), the Static Metascore, and one score that is not specific to HS: Dermatology Life Quality Index (DLQI). A second set of patients illustrates how some scores change over time and with treatment: Hurley, Hurley Staging refined, Sartorius 2003, Sartorius 2007, HS-PGA, IHS4, SAHS, AISI, Hidradenitis Suppurativa Clinical Response (HiSCR), the very new iHS4-55, the Dynamic Metascore, and DLQI.
Nineteen scores are detailed in this overview. We illustrate that for some patients, the scores do not predictably and consistently correlate with each other, either in an evaluation of the severity at a time-point t, or in the evaluation of the response to a treatment. Some patients in this cohort may be considered responders according to some scores, but non-responders according to others. The clinical heterogeneity of the disease, represented by its many phenotypes, seems partly to explain this difference.
These examples illustrate how the choice of a score can lead to different interpretations of the response to a treatment, or even potentially change the results of a randomized clinical trial.
化脓性汗腺炎（HS）部分由于其临床异质性，难以准确评分；大量的疾病评分就说明了这一点。2016年，英格拉姆等人进行的一项系统评价报告了约30种评分的使用情况，从那时起，这个数字进一步增加。我们的目标有两个：对迄今为止使用的评分进行简洁而详细的叙述性综述，并针对个体患者对这些评分进行相互比较。
在谷歌、谷歌学术、PubMed、ScienceDirect和考科蓝上对英文和法文文章进行文献综述。为了说明评分之间的差异，选取了纳入欧洲HS登记处的一些比利时患者的数据。第一组患者比较了以下评分的严重程度：赫尔利评分、改良的赫尔利分期、三个版本的萨托里乌斯评分（2003年、2007年、2009年）、化脓性汗腺炎医生整体评估（HS-PGA）、国际化脓性汗腺炎严重程度评分系统（IHS4）、化脓性汗腺炎严重程度评估（SAHS）、化脓性汗腺炎严重指数（HSSI）、反向痤疮严重指数（AISI）、静态元评分，以及一个非HS特异性评分：皮肤病生活质量指数（DLQI）。第二组患者说明了一些评分如何随时间和治疗而变化：赫尔利评分、改良的赫尔利分期、2003年萨托里乌斯评分、2007年萨托里乌斯评分、HS-PGA、IHS4、SAHS、AISI、化脓性汗腺炎临床反应（HiSCR）、非常新的iHS4-55、动态元评分和DLQI。
本综述详细介绍了19种评分。我们表明，对于一些患者，无论是在时间点t评估严重程度，还是在评估对治疗的反应时，这些评分之间都没有可预测且一致的相关性。根据某些评分，该队列中的一些患者可能被视为反应者，但根据其他评分则可能被视为无反应者。该疾病由其多种表型所代表的临床异质性似乎部分解释了这种差异。
这些例子说明了评分的选择如何导致对治疗反应的不同解释，甚至可能改变随机临床试验的结果。
