The predictive value of aGAPSS score combined with clinical factors for thrombosis in systemic lupus erythematosus

Abstract

This study evaluated the predictive value of antiphospholipid antibodies (aPLs) combined with the adjusted global antiphospholipid syndrome score (aGAPSS) for thrombosis in hospitalized systemic lupus erythematosus (SLE) patients. A retrospective analysis included 309 SLE patients (65 with in-hospital thrombosis, 244 without). Demographic, clinical, and serological data were collected. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression identified independent risk factors. A combined predictive model was constructed and internally validated using bootstrap. Patients with thrombosis were older, had higher smoking prevalence, LA ratio, and aGAPSS (all P  < 0.05). Disease activity was significantly higher in the thrombosis group, as reflected by a higher mean SLEDAI score (14.29 ± 2.88 vs. 12.45 ± 1.62, P  < 0.001). Multivariate analysis identified age (OR = 1.053), smoking (OR = 2.945), SLEDAI (OR = 1.312), LA ratio (OR = 17.432), and aGAPSS (OR = 1.514) as independent predictors. The combined model (aGAPSS + clinical covariates) achieved an area under the curve (AUC) of 0.832, significantly outperforming aGAPSS alone (AUC = 0.693; ΔAUC = 0.139, P  < 0.001), with NRI of 0.356 and IDI of 0.142. Integrating aGAPSS with clinical factors provides good discriminative ability for in-hospital thrombosis risk stratification in hospitalized SLE patients, offering a practical tool that may inform surveillance intensity and prophylactic consideration.