GAPSS: the Global Anti-Phospholipid Syndrome Score

Rheumatology (Oxford). 2013 Aug;52(8):1397-403. doi: 10.1093/rheumatology/kes388. Epub 2013 Jan 12.


Objective: To develop and validate a risk score [global APS score (GAPSS)] derived from the combination of independent risk for thrombosis and pregnancy loss (PL), taking into account the aPL profile, conventional cardiovascular risk factors and the autoimmune antibody profile.

Methods: This cross-sectional study included 211 consecutive SLE patients. Data on clinical manifestations, conventional cardiovascular risk factors, aPL profile, ANAs, ENA and anti-dsDNA were collected. Long-term low-dose aspirin, oral anticoagulant and HCQ treatment were also included in the analysis. Patients were randomly divided into two sets by a computer-generated randomized list. We developed GAPSS in the first set of patients (n = 106), assigning the risk factors identified by multivariate analysis weighted points proportional to the β-regression coefficient values. GAPSS was validated in the second set of patients (n = 105). The relationship between GAPPS and thrombosis and/or PL was analysed.

Results: In the first set, higher values of GAPSS were seen in patients who experienced thrombosis and/or PL compared with those without clinical events [GAPSS 9.3 (4.8) (range 1-19) and 5.3 (4) (range 0-16), P < 0.001]. Also taken separately, patients who experienced thrombosis or PL showed higher GAPSS compared with those without clinical events [GAPSS 9.6 (4.8) (range 1-19) vs 4.9 (5) (range 0-14), P = 0.027 for thrombosis; 7.3 (5) vs 3.9 (5.1) (range 0-16), P = 0.024 for PL, respectively]. In the second set, the results were similar, with statistically higher values of GAPSS in patients with a clinical history of thrombosis and/or PL compared with those without events [GAPSS 9.5 (5.6) (range 0-20) and 3.9 (4.1) (range 0-17), P < 0.001). Higher values were also seen when subclassifying the patients according to the clinical manifestation, thrombosis or PL [GAPSS 9.5 (5.6) (range 0-20) vs 4.8 (5.4) (range 0-17), P = 0.036 for thrombosis; 7.9 (3.3) vs 3.8 (5.4) (range 0-16), P = 0.037 for PL, respectively).

Conclusion: These data propose a substantial improvement in risk prediction of thrombosis or PL in SLE based on assessment of the GAPSS, a quantitative scoring system.

Keywords: Hughes syndrome; antiphospholipid antibodies; pregnancy loss; prothrombin; thrombosis.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Abortion, Spontaneous / diagnosis
  • Abortion, Spontaneous / immunology*
  • Adult
  • Analysis of Variance
  • Antibodies, Antiphospholipid / immunology*
  • Antiphospholipid Syndrome / diagnosis*
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / immunology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Logistic Models
  • Lupus Erythematosus, Systemic / diagnosis*
  • Middle Aged
  • Multivariate Analysis
  • Pregnancy
  • Prothrombin / metabolism
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Thrombosis / diagnosis*
  • Thrombosis / immunology
  • United Kingdom


  • Antibodies, Antiphospholipid
  • Prothrombin