Predictive role of capillaroscopic skin ulcer risk index in systemic sclerosis: A multicentre validation study

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RESEARCH PRODUCT

Predictive role of capillaroscopic skin ulcer risk index in systemic sclerosis: A multicentre validation study

Michele Iudici Roberto D'amico Salvatore Mazzuca Michele Colaci Clodoveo Ferri G. Vukatana A. Principato Andreina Teresa Manfredi M. Bocci P Del Medico Marco Sebastiani R. De Angelis L. Riato R. Vicini S. Moscatelli

subject

Adult Male medicine.medical_specialty Validation study predictive model; capillaroscopic skin ulcer; systematic sceloris Immunology Risk Assessment General Biochemistry Genetics and Molecular Biology Scleroderma Microscopic Angioscopy Scleroderma Fingers Rheumatology Internal medicine Risk index Epidemiology Skin Ulcer medicine Immunology and Allergy Humans Aged Skin Scleroderma Systemic Receiver operating characteristic business.industry Systemic Area under the curve Skin ulcer Middle Aged medicine.disease Connective tissue disease Surgery Capillaries Early Diagnosis Nails Female medicine.symptom business Epidemiologic Methods Algorithms

description

IntroductionThe early detection of systemic sclerosis (SSc) patients at high risk of developing digital ulcers could allow preventive treatment, with a reduction of morbidity and social costs. In 2009, a quantitative score, the capillaroscopic skin ulcer risk index (CSURI), calculated according to the formula ‘D×M/N2’, was proposed, which was highly predictive of the appearance of scleroderma digital ulcers within 3 months of capillaroscopic evaluation.ObjectivesThis multicentre study aims to validate the predictive value and reproducibility of CSURI in a large population of SSc patients.MethodsCSURI was analysed in 229 unselected SSc patients by nailfold videocapillaroscopy (NVC). All patients were re-evaluated 3 months later with regard to the persistence and/or appearance of new digital ulcers.Results57 of 229 patients presented with digital ulcers after 3 months. The receiver operating characteristic curve analysis showed an area under the curve of 0.884 (95% CI 0.835 to 0.922), with specificity and sensitivity of 81.4% (95% CI 74.8 to 86.89) and 92.98% (95% CI 83.0 to 98.0), respectively, at the cut-off value of 2.96. The reproducibility of CSURI was validated on a random sample of 81 patients, with a κ-statistic measure of interrater agreement of 0.8514.ConclusionsThe role of CSURI was confirmed in detecting scleroderma patients with a significantly high risk of developing digital ulcers within the first 3 months from NVC evaluation. CSURI is the only method validated to predict the appearance of digital ulcers and its introduction into routine clinical practice might help optimise the therapeutic strategy of these harmful SSc complications.

year	journal	country	edition	language
2012-01-01

10.1136/annrheumdis-2011-200022 http://hdl.handle.net/20.500.11769/503891