Internal Medicine Department, Hospital Santa Maria, Unidade Local de Saúde Santa Maria, Lisbon, Portugal.
Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal.
Lupus. 2024 Jun;33(7):716-727. doi: 10.1177/09612033241246360. Epub 2024 Apr 14.
We aim to independently assess the validity of the damage index for antiphospholipid syndrome (DIAPS) in thrombotic antiphospholipid syndrome (APS) patients by exploring the prevalence and risk factors of organ damage and evaluating its impact on health-related quality of life (HR-QoL).
Cross-sectional study including all thrombotic APS patients (Sydney criteria) attending a Portuguese tertiary centre. Damage was assessed using the DIAPS, and HR-QoL using the 3- and 5-level EuroQol HR-QoL (EQ-D5-3L and 5L), and Visual Analogue Scale (VAS) applied via a phone questionnaire. Spearman's correlation between DIAPS and the HR-QoL scales was performed. Risk factors for damage accrual and HR-QoL impairment were explored using univariate and multivariate logistic regression.
Among the 108 patients (female, 65.7%; white, 90.7%; primary APS, 75.9%; median disease duration, 6 years), damage (DIAPS≥1) developed in 48.2% of patients (mean ± SD DIAPS, 3.08 ± 1.83). DIAPS's neuropsychiatric domain was the most affected (24.2%), followed by the peripheral vascular domain (20.3%). No clinical, demographic nor laboratory parameters were significantly associated with damage. Regarding HR-QoL, pain/discomfort, anxiety/depression and usual activities domains were the most frequently impaired in both scales. DIAPS's domains correlated similarly with the EQ-5D-3L and 5L scales' individual domains. Female sex, medical disorders, secondary APS and type of presenting thrombosis (arterial) increased the risk of HR-QoL impairment. Total DIAPS was associated with higher odds of mobility, self-care and pain/discomfort impairment in both EQ-5D-3L and 5L scales but lost its independent risk in multivariable analysis.
This external validation of DIAPS reinforces the ability of the score to correlate with HR-QoL while also highlighting risk factors for HR-QoL impairment other than damage accrual.
通过探讨器官损伤的发生率和危险因素，并评估其对健康相关生活质量（HR-QoL）的影响，我们旨在独立评估抗磷脂综合征（APS）患者血栓性 APS 中抗磷脂抗体综合征损伤指数（DIAPS）的有效性。
本研究为一项纳入葡萄牙一家三级中心所有血栓性 APS 患者（悉尼标准）的横断面研究。采用 DIAPS 评估损伤，通过电话问卷调查评估 HR-QoL，使用 3 级和 5 级欧洲五维健康量表（EQ-D5-3L 和 5L）和视觉模拟量表（VAS）。采用 Spearman 相关分析评估 DIAPS 与 HR-QoL 量表之间的相关性。采用单因素和多因素 logistic 回归分析探讨损伤累积和 HR-QoL 受损的危险因素。
在 108 例患者中（女性占 65.7%，白种人占 90.7%，原发性 APS 占 75.9%，中位疾病持续时间为 6 年），48.2%的患者出现了损伤（DIAPS≥1）（平均±标准差 DIAPS，3.08±1.83）。DIAPS 的神经精神域受影响最严重（24.2%），其次是周围血管域（20.3%）。无临床、人口统计学或实验室参数与损伤显著相关。关于 HR-QoL，两个量表中疼痛/不适、焦虑/抑郁和日常活动领域最常受损。DIAPS 的各个领域与 EQ-5D-3L 和 5L 量表的个体领域具有相似的相关性。女性、合并疾病、继发性 APS 和首发血栓类型（动脉）增加了 HR-QoL 受损的风险。在 EQ-5D-3L 和 5L 量表中，总 DIAPS 与移动、自理和疼痛/不适受损的可能性更大相关，但在多变量分析中失去了其独立风险。
DIAPS 的此次外部验证不仅强化了评分与 HR-QoL 相关的能力，还突出了除损伤累积以外影响 HR-QoL 受损的危险因素。
