Foddai Silvia Grazietta, Infantino Maria, Manfredi Mariangela, Pavia Francesca, Benucci Maurizio, Li Gobbi Francesca, Radin Massimo, Cecchi Irene, Barinotti Alice, Sciascia Savino
University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERKNet, ERN-Reconnet and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Turin, 10154, Italy.
Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
Immunol Res. 2025 Sep 16;73(1):130. doi: 10.1007/s12026-025-09682-x.
Efficient utilization of healthcare resources, including laboratory testing, is crucial for environmental sustainability and cost-effectiveness. The diagnosis of APS requires the presence of at least one clinical event (either an objectively confirmed thrombotic event and/or pregnancy complication) and detection of one or more aPL (lupus anticoagulant [LA], IgG/IgM anticardiolipin [aCL], and/or IgG/IgM anti-β2 glycoprotein-1 [aβ2GPI]). However, inappropriate requests for aPL tests contribute to unnecessary healthcare expenses and environmental impact. This study evaluates the appropriateness of aPL testing in a clinical setting. A retrospective analysis was conducted on 642 patients attending the San Giovanni Di Dio Hospital, Florence (11/2023-02/2024). Diagnostic suspicion underlying aPL test requests were classified as appropriate, inappropriate, or unevaluable using a scoring system based on clinical recommendations. Appropriateness assessment was performed independently by two researchers and reconciled with a third expert. Patient demographics, test results, and the specialty of the physicians ordering aPL were recorded and analyzed. Of the 642 queries, 36% were deemed appropriate, 42% inappropriate, and 22% unevaluable. Family physicians accounted for 53% of all test requests but exhibited the highest rate of inappropriate requests (44%). Rheumatologists, internal medicine physicians, and gynecologists demonstrated better adherence to recommendations (with 34%, 30%, and 18% of inappropriate requests, respectively). Only 4.9% of patients underwent comprehensive aPL testing per international standards (Sidney criteria). Among the 115 aPL-positive cases, multiple antibody positivity was more common in appropriate test requests. Inappropriate requests often stemmed from conditions without established links to APS, such as alopecia, hypercholesterolemia, and dysmenorrhea. A considerable proportion of aPL testing in routine practice lacks clinical justification, reflecting variability in guideline adherence across specialties. Inappropriate testing increases healthcare costs, specialist referrals, and environmental burdens. Improved education, adherence to diagnostic recommendations, and sustainable practices are critical to optimizing APS testing and resource utilization.
有效利用包括实验室检测在内的医疗资源，对于环境可持续性和成本效益至关重要。抗磷脂综合征（APS）的诊断需要至少存在一种临床事件（客观确认的血栓形成事件和/或妊娠并发症），并检测到一种或多种抗磷脂抗体（aPL，狼疮抗凝物[LA]、IgG/IgM抗心磷脂[aCL]和/或IgG/IgM抗β2糖蛋白1[aβ2GPI]）。然而，对aPL检测的不适当请求会导致不必要的医疗费用和环境影响。本研究评估了临床环境中aPL检测的适当性。对佛罗伦萨圣乔瓦尼迪奥医院（2023年11月至2024年2月）的642例患者进行了回顾性分析。根据临床建议使用评分系统，将aPL检测请求背后的诊断怀疑分为适当、不适当或不可评估。由两名研究人员独立进行适当性评估，并与第三位专家进行核对。记录并分析患者的人口统计学信息、检测结果以及开具aPL检测的医生的专业。在642份检测请求中，36%被认为是适当的，42%是不适当的，22%是不可评估的。家庭医生占所有检测请求的53%，但其不适当请求的比例最高（44%）。风湿病学家、内科医生和妇科医生对建议的遵循情况更好（不适当请求的比例分别为34%、30%和18%）。根据国际标准（悉尼标准），只有4.9%的患者接受了全面的aPL检测。在115例aPL阳性病例中，多种抗体阳性在适当的检测请求中更为常见。不适当的请求往往源于与APS无既定关联的情况，如脱发、高胆固醇血症和痛经。常规实践中相当一部分aPL检测缺乏临床依据，这反映了各专业在遵循指南方面的差异。不适当的检测会增加医疗成本、专科转诊和环境负担。加强教育、遵循诊断建议和采取可持续做法对于优化APS检测和资源利用至关重要。
