Underperformance of clinical risk scores in identifying vascular ultrasound-based high cardiovascular risk in systemic lupus erythematosus
Underperformance of clinical risk scores in identifying vascular ultrasound-based high cardiovascular risk in systemic lupus erythematosus
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DOI：
10.1177/2047487320906650
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发表时间：
2020-03-02
影响因子：
8.3
通讯作者：
Tektonidou, Maria G.
中科院分区：
文献类型：
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作者：
Drosos, George C.;Konstantonis, George;Tektonidou, Maria G.
目的本研究的目的是评估8个临床风险预测评分的性能，以确定系统性红斑狼疮（SLE）患者的心血管疾病（CVD）高风险，如动脉粥样硬化斑块的存在所定义的。（女性：93.3%，平均年龄：44.8 +/-12年），使用5种通用（系统性冠状动脉风险评估（SCORE）、Fragrance风险评分（FRS）、合并队列风险方程（ASCVD）、Globorisk、前瞻性心血管Munster研究风险计算器（PROCAM））和三个"SLE适应"（改良的SCORE、改良的FRS、QRESEARCH风险评估器，第3版（QRISK3））CVD风险评分，以及颈动脉和股动脉的超声检查。对所有风险模型评估了基于动脉粥样硬化斑块的存在来识别高CVD风险的校准、区分和分类措施。通过合并超声结果，对所有评分进行CVD风险重新分类。（p值范围为0.38 - 0.63）和区分度（曲线下面积0.73 - 0.84），和低到中等的敏感性（8.3 - 71.4%）和分类能力所有风险模型均观察到（马修斯相关系数（MCC）0.25 - 0.47），以将任何动脉部位存在斑块的患者识别为高风险。改良FRS与FRS相比，MCC有所改善（0.43 vs 0.36），但改良SCORE与SCORE相比无改善（0.25 vs 0.25）。根据斑块存在情况，在QRISK3、改良FRS、Globorisk、FRS/PROCAM、ASCVD、改良SCORE和SCORE分类为非高风险的病例中，10%、16.1%、20.5%、21.5%、24%、28.2%和28.6%的CVD风险升级为高风险，结论：大多数五个通用和三个“SLE适应”临床风险评分低估了SLE患者动脉粥样硬化斑块存在定义的高CVD风险。
AimsThe aim of this study was to assess the performance of eight clinical risk prediction scores to identify individuals with systemic lupus erythematosus (SLE) at high cardiovascular disease (CVD) risk, as defined by the presence of atherosclerotic plaques.MethodsCVD risk was estimated in 210 eligible SLE patients without prior CVD or diabetes mellitus (female: 93.3%, mean age: 44.8 +/- 12 years) using five generic (Systematic Coronary Risk Evaluation (SCORE), Framingham Risk Score (FRS), Pooled Cohort Risk Equations (ASCVD), Globorisk, Prospective Cardiovascular Munster Study risk calculator (PROCAM)) and three 'SLE-adapted' (modified-SCORE, modified-FRS, QRESEARCH risk estimator, version 3 (QRISK3)) CVD risk scores, as well as ultrasound examination of the carotid and femoral arteries. Calibration, discrimination and classification measures to identify high CVD risk based on the presence of atherosclerotic plaques were assessed for all risk models. CVD risk reclassification was applied for all scores by incorporating ultrasound results.ResultsModerate calibration (p-value range from 0.38 to 0.63) and discrimination (area under the curve 0.73-0.84), and low-to-moderate sensitivity (8.3-71.4%) and classification ability (Matthews correlation coefficient (MCC) 0.25-0.47) were observed for all risk models to identify patients with plaques at any arterial site as high-risk. MCC was improved for modified-FRS versus FRS (0.43 vs 0.36), but not for modified-SCORE versus SCORE (0.25 vs 0.25). Based on plaque presence, CVD risk was upgraded to high-risk in 10%, 16.1%, 20.5%, 21.5%, 24%, 28.2% and 28.6% of cases classified as non-high-risk by QRISK3, modified-FRS, Globorisk, FRS/PROCAM, ASCVD, modified-SCORE and SCORE, respectively.ConclusionsMost of the five generic and three 'SLE-adapted' clinical risk scores underestimated high CVD risk defined by atherosclerotic plaque presence in patients with SLE.