Accuracy of Anticardiolipin Antibodies in Identifying a History of Thrombosis Among Patients With Systemic Lupus Erythematosus
To measure the accuracy of anticardiolipin antibodies (aCL) in identifying a history of thrombosis among patients with systemic lupus erythematosus (SLE) or the primary antiphospholipid syndrome (PAPS). Patients with SLE or PAPS who attended our rheumatology clinic between April 1992 and March 1994...
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| Veröffentlicht in: | The American journal of medicine 1995-06, Vol.98 (6), p.559-565 |
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| creator | Escalante, Agustín L. Brey, Robin D.Mitchell, Braxton Dreiner, Ute |
| description | To measure the accuracy of anticardiolipin antibodies (aCL) in identifying a history of thrombosis among patients with systemic lupus erythematosus (SLE) or the primary antiphospholipid syndrome (PAPS).
Patients with SLE or PAPS who attended our rheumatology clinic between April 1992 and March 1994 were included in a retrospective analysis of the relationship between thrombotic events and aCL. All aCL measurements were performed in the same laboratory by enzyme-linked immunosorbent assay, blinded as to the presence or absence of thrombosis. The diagnostic accuracy of IgG, IgM, and IgA aCL was quantified by means of the receiver operating characteristic area under the curve (ROC AUC) for each isotype. Stratum-specific likelihood ratios and their 95% confidence intervals were calculated to define strata with optimal discriminant power.
results: During the period of study, aCL was measured in 117 patients (113 SLE and 4 PAPS), of whom 24 (20.5%) had experienced thrombotic events. The ROC AUC ± the standard error for IgG aCL was 0.81 ± 0.05, signifying an 81% accuracy in the identification of a history of thrombosis. In contrast, the accuracy of the IgM and IgA aCL was significantly lower (0.60 ± 0.08 and 0.54 ± 0.07, respectively,
P < 0.05). Using stratumspecific likelihood ratios, we defined three strata in the IgG aCL scale that discriminate between patients with low, indeterminate, and high probabilities of thrombosis. For IgG aCL levels below 21.4 IgG phospholipid (GPL) U/mL, the posttest probability of thrombosis was 0.07, whereas for IgG aCL levels ≥65.1 GPL U/mL, the posttest probability of thrombosis was 0.75. For IgG aCL values between 21.4 and 65.0 GPL U/mL, the probability of thrombosis was 0.20, equivalent to the entire cohort.
The IgG aCL determinations perform well in the identification of thrombosis in SLE or PAPS, while the IgM and IgA aCL have poor diagnostic accuracy. These findings may have implications for management of these patients. |
| doi_str_mv | 10.1016/S0002-9343(99)80014-X |
| format | Article |
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Patients with SLE or PAPS who attended our rheumatology clinic between April 1992 and March 1994 were included in a retrospective analysis of the relationship between thrombotic events and aCL. All aCL measurements were performed in the same laboratory by enzyme-linked immunosorbent assay, blinded as to the presence or absence of thrombosis. The diagnostic accuracy of IgG, IgM, and IgA aCL was quantified by means of the receiver operating characteristic area under the curve (ROC AUC) for each isotype. Stratum-specific likelihood ratios and their 95% confidence intervals were calculated to define strata with optimal discriminant power.
results: During the period of study, aCL was measured in 117 patients (113 SLE and 4 PAPS), of whom 24 (20.5%) had experienced thrombotic events. The ROC AUC ± the standard error for IgG aCL was 0.81 ± 0.05, signifying an 81% accuracy in the identification of a history of thrombosis. In contrast, the accuracy of the IgM and IgA aCL was significantly lower (0.60 ± 0.08 and 0.54 ± 0.07, respectively,
P < 0.05). Using stratumspecific likelihood ratios, we defined three strata in the IgG aCL scale that discriminate between patients with low, indeterminate, and high probabilities of thrombosis. For IgG aCL levels below 21.4 IgG phospholipid (GPL) U/mL, the posttest probability of thrombosis was 0.07, whereas for IgG aCL levels ≥65.1 GPL U/mL, the posttest probability of thrombosis was 0.75. For IgG aCL values between 21.4 and 65.0 GPL U/mL, the probability of thrombosis was 0.20, equivalent to the entire cohort.
The IgG aCL determinations perform well in the identification of thrombosis in SLE or PAPS, while the IgM and IgA aCL have poor diagnostic accuracy. These findings may have implications for management of these patients.</description><identifier>ISSN: 0002-9343</identifier><identifier>EISSN: 1555-7162</identifier><identifier>DOI: 10.1016/S0002-9343(99)80014-X</identifier><identifier>PMID: 7778571</identifier><identifier>CODEN: AJMEAZ</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Antibodies, Anticardiolipin - blood ; Antiphospholipid Syndrome - immunology ; Biochemistry ; Biological and medical sciences ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulin A - blood ; Immunoglobulin G - blood ; Immunoglobulin M - blood ; Lipids ; Lupus Erythematosus, Systemic - complications ; Lupus Erythematosus, Systemic - immunology ; Male ; Medical disorders ; Medical sciences ; Middle Aged ; Predictive Value of Tests ; ROC Curve ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Single-Blind Method ; Thrombosis - immunology</subject><ispartof>The American journal of medicine, 1995-06, Vol.98 (6), p.559-565</ispartof><rights>2004</rights><rights>1995 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. Jun 1995</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-d4f966d7491dab70d55aec31c049ae8bd19f5dc3fcfe53b36b5495797d5a40643</citedby><cites>FETCH-LOGICAL-c445t-d4f966d7491dab70d55aec31c049ae8bd19f5dc3fcfe53b36b5495797d5a40643</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S000293439980014X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3542652$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7778571$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Escalante, Agustín</creatorcontrib><creatorcontrib>L. Brey, Robin</creatorcontrib><creatorcontrib>D.Mitchell, Braxton</creatorcontrib><creatorcontrib>Dreiner, Ute</creatorcontrib><title>Accuracy of Anticardiolipin Antibodies in Identifying a History of Thrombosis Among Patients With Systemic Lupus Erythematosus</title><title>The American journal of medicine</title><addtitle>Am J Med</addtitle><description>To measure the accuracy of anticardiolipin antibodies (aCL) in identifying a history of thrombosis among patients with systemic lupus erythematosus (SLE) or the primary antiphospholipid syndrome (PAPS).
Patients with SLE or PAPS who attended our rheumatology clinic between April 1992 and March 1994 were included in a retrospective analysis of the relationship between thrombotic events and aCL. All aCL measurements were performed in the same laboratory by enzyme-linked immunosorbent assay, blinded as to the presence or absence of thrombosis. The diagnostic accuracy of IgG, IgM, and IgA aCL was quantified by means of the receiver operating characteristic area under the curve (ROC AUC) for each isotype. Stratum-specific likelihood ratios and their 95% confidence intervals were calculated to define strata with optimal discriminant power.
results: During the period of study, aCL was measured in 117 patients (113 SLE and 4 PAPS), of whom 24 (20.5%) had experienced thrombotic events. The ROC AUC ± the standard error for IgG aCL was 0.81 ± 0.05, signifying an 81% accuracy in the identification of a history of thrombosis. In contrast, the accuracy of the IgM and IgA aCL was significantly lower (0.60 ± 0.08 and 0.54 ± 0.07, respectively,
P < 0.05). Using stratumspecific likelihood ratios, we defined three strata in the IgG aCL scale that discriminate between patients with low, indeterminate, and high probabilities of thrombosis. For IgG aCL levels below 21.4 IgG phospholipid (GPL) U/mL, the posttest probability of thrombosis was 0.07, whereas for IgG aCL levels ≥65.1 GPL U/mL, the posttest probability of thrombosis was 0.75. For IgG aCL values between 21.4 and 65.0 GPL U/mL, the probability of thrombosis was 0.20, equivalent to the entire cohort.
The IgG aCL determinations perform well in the identification of thrombosis in SLE or PAPS, while the IgM and IgA aCL have poor diagnostic accuracy. These findings may have implications for management of these patients.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antibodies, Anticardiolipin - blood</subject><subject>Antiphospholipid Syndrome - immunology</subject><subject>Biochemistry</subject><subject>Biological and medical sciences</subject><subject>Enzyme-Linked Immunosorbent Assay</subject><subject>Female</subject><subject>Humans</subject><subject>Immunoglobulin A - blood</subject><subject>Immunoglobulin G - blood</subject><subject>Immunoglobulin M - blood</subject><subject>Lipids</subject><subject>Lupus Erythematosus, Systemic - complications</subject><subject>Lupus Erythematosus, Systemic - immunology</subject><subject>Male</subject><subject>Medical disorders</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>ROC Curve</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Single-Blind Method</subject><subject>Thrombosis - immunology</subject><issn>0002-9343</issn><issn>1555-7162</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUGLFDEQhYMo67j6ExaCiOihNekknc5JhmV1FwYUdsW9hXSSdrJ0d8ZUWuiLv93szDAHL56KR32vKN5D6IKSD5TQ5uMtIaSuFOPsnVLvW0Ior-6foBUVQlSSNvVTtDohz9ELgIciiRLNGTqTUrZC0hX6s7Z2TsYuOPZ4PeVgTXIhDmEXpr3uogsecFE3zhfdL2H6iQ2-DpBj2tvutimOXYQAeD3Gsv1mcigs4B8hb_HtAtmPweLNvJsBX6Ulb_1ocoQZXqJnvRnAvzrOc_T989Xd5XW1-frl5nK9qSznIleO96ppnOSKOtNJ4oQw3jJqCVfGt52jqhfOst72XrCONZ3gSkglnTCcNJydo7eHu7sUf80esh4DWD8MZvJxBi0lq2vF2wK-_gd8iHOaym-6ZjUTrWCqQOIA2RQBku_1LoXRpEVToh_L0fty9GPyWim9L0ffF9_F8fjcjd6dXMc2yv7NcW_AmqFPZrIBThgTvG5EXbBPB8yXxH4HnzTYkrf1LiRvs3Yx_OeRv-OQrXQ</recordid><startdate>19950601</startdate><enddate>19950601</enddate><creator>Escalante, Agustín</creator><creator>L. Brey, Robin</creator><creator>D.Mitchell, Braxton</creator><creator>Dreiner, Ute</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Sequoia S.A</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>19950601</creationdate><title>Accuracy of Anticardiolipin Antibodies in Identifying a History of Thrombosis Among Patients With Systemic Lupus Erythematosus</title><author>Escalante, Agustín ; L. Brey, Robin ; D.Mitchell, Braxton ; Dreiner, Ute</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-d4f966d7491dab70d55aec31c049ae8bd19f5dc3fcfe53b36b5495797d5a40643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Antibodies, Anticardiolipin - blood</topic><topic>Antiphospholipid Syndrome - immunology</topic><topic>Biochemistry</topic><topic>Biological and medical sciences</topic><topic>Enzyme-Linked Immunosorbent Assay</topic><topic>Female</topic><topic>Humans</topic><topic>Immunoglobulin A - blood</topic><topic>Immunoglobulin G - blood</topic><topic>Immunoglobulin M - blood</topic><topic>Lipids</topic><topic>Lupus Erythematosus, Systemic - complications</topic><topic>Lupus Erythematosus, Systemic - immunology</topic><topic>Male</topic><topic>Medical disorders</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>ROC Curve</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Single-Blind Method</topic><topic>Thrombosis - immunology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Escalante, Agustín</creatorcontrib><creatorcontrib>L. Brey, Robin</creatorcontrib><creatorcontrib>D.Mitchell, Braxton</creatorcontrib><creatorcontrib>Dreiner, Ute</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Escalante, Agustín</au><au>L. Brey, Robin</au><au>D.Mitchell, Braxton</au><au>Dreiner, Ute</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Accuracy of Anticardiolipin Antibodies in Identifying a History of Thrombosis Among Patients With Systemic Lupus Erythematosus</atitle><jtitle>The American journal of medicine</jtitle><addtitle>Am J Med</addtitle><date>1995-06-01</date><risdate>1995</risdate><volume>98</volume><issue>6</issue><spage>559</spage><epage>565</epage><pages>559-565</pages><issn>0002-9343</issn><eissn>1555-7162</eissn><coden>AJMEAZ</coden><abstract>To measure the accuracy of anticardiolipin antibodies (aCL) in identifying a history of thrombosis among patients with systemic lupus erythematosus (SLE) or the primary antiphospholipid syndrome (PAPS).
Patients with SLE or PAPS who attended our rheumatology clinic between April 1992 and March 1994 were included in a retrospective analysis of the relationship between thrombotic events and aCL. All aCL measurements were performed in the same laboratory by enzyme-linked immunosorbent assay, blinded as to the presence or absence of thrombosis. The diagnostic accuracy of IgG, IgM, and IgA aCL was quantified by means of the receiver operating characteristic area under the curve (ROC AUC) for each isotype. Stratum-specific likelihood ratios and their 95% confidence intervals were calculated to define strata with optimal discriminant power.
results: During the period of study, aCL was measured in 117 patients (113 SLE and 4 PAPS), of whom 24 (20.5%) had experienced thrombotic events. The ROC AUC ± the standard error for IgG aCL was 0.81 ± 0.05, signifying an 81% accuracy in the identification of a history of thrombosis. In contrast, the accuracy of the IgM and IgA aCL was significantly lower (0.60 ± 0.08 and 0.54 ± 0.07, respectively,
P < 0.05). Using stratumspecific likelihood ratios, we defined three strata in the IgG aCL scale that discriminate between patients with low, indeterminate, and high probabilities of thrombosis. For IgG aCL levels below 21.4 IgG phospholipid (GPL) U/mL, the posttest probability of thrombosis was 0.07, whereas for IgG aCL levels ≥65.1 GPL U/mL, the posttest probability of thrombosis was 0.75. For IgG aCL values between 21.4 and 65.0 GPL U/mL, the probability of thrombosis was 0.20, equivalent to the entire cohort.
The IgG aCL determinations perform well in the identification of thrombosis in SLE or PAPS, while the IgM and IgA aCL have poor diagnostic accuracy. These findings may have implications for management of these patients.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>7778571</pmid><doi>10.1016/S0002-9343(99)80014-X</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Antibodies, Anticardiolipin - blood Antiphospholipid Syndrome - immunology Biochemistry Biological and medical sciences Enzyme-Linked Immunosorbent Assay Female Humans Immunoglobulin A - blood Immunoglobulin G - blood Immunoglobulin M - blood Lipids Lupus Erythematosus, Systemic - complications Lupus Erythematosus, Systemic - immunology Male Medical disorders Medical sciences Middle Aged Predictive Value of Tests ROC Curve Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Single-Blind Method Thrombosis - immunology |
| title | Accuracy of Anticardiolipin Antibodies in Identifying a History of Thrombosis Among Patients With Systemic Lupus Erythematosus |
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