POS1462-HPR NEW VERSION OF DAMAGE INDEX IN THROMBOTIC ANTIPHOSPHOLIPID SYNDROME: DIAPSV2
Authors: M. V. Goycochea Robles, G. Medina, C. Mendoza, C. I. Melendez Mercado, L. A. Martinez Martinez, P. Medina San Millan, A. Perez Ruiz, S. Guzman, M. D. C. Amigo Castañeda
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Antiphospholipid Primary Syndrome (APS) has significant impact, especially by thrombotic manifestations. Take up the real consequence of this serious entity is necessary. DIAPS is specific and clinical instrument that distinguish disease activity from damage; its initial development in Latin American patients, demonstrated internal validity (content, criterion, and construct validity) and good correlation with quality of life [1]. DIAPS is a new and promising damage score system for thrombotic APS, and needs continuous revision, also an updated version. <h3>Objectives:</h3> 1) Assess external validity of DIAPS; To know the feasibility, appropriateness, and utility application of DIAPS in real clinical and research world. 2) Validate a new version of cumulative damage index (DIAPSv2). <h3>Methods:</h3> The methodological approach includes 2 phases: Literature review and Panel Delphi exercise 1) A scope review was conducted, through a systematic search of health databases looking studies assessing cumulative damage in APS with DIAPS; identifying the available evidence of application of DIAPS and examine how research is conducting on cumulative damage in APS. Period of search: Dec 2015-Dec 2023; All ages and any clinical design were included. No restriction in languages. Terms of search: #Antiphospholipid Primary Syndrome, # Antiphospholipid Secondary Syndrome AND, OR, # Cumulative damage, #chronic damage index. The studies selected were evaluated by 2 reviewers (SVG and MVGR), to report characteristics of population, clinical design, associations, and outcomes. Phase 2) An initial step with revision of original and generation of new items through 3 rounds by Modified Panel <i>Delphi</i> of 10 rheumatologist (clinical experts in APS care patients and/or experts in clinimetric methodology). The last 2 rounds included 24 experts in specific domains (cardiology, pneumology, neurology, nephrology, ophthalmology, vascular, dermatology, image, orthopedic). Participants were invited to approve the item and their respective definition. Concordance was defined &gt;90%. <h3>Results:</h3> 1)Literature review: 15 studies applied DIAPS summarizing 2340 patients in different populations, and diverse groups of age, including a paediatric cohort and different population of the original Latin American where DIAPS where validated (2). Regarding design: 10 longitudinal, retrospective studies including primary and secondary APS and 3 cross sectional surveys. The outcomes reported: significative relation with clinical, laboratory features, comorbidity, quality of life and DIAPS scores. Two surveys detected differences in DIAPS between patients with Lupus and APS diagnosis. One study calculated prediction of mortality; and the association with others constructed scores like adjusted global antiphospholipid score were reported. 2) Generation of 54 items from 38 original were generated in the first round, and were accepted 37, 36 included in original domains, and one new domain was established: damage caused by chronic anticoagulation. Neuropsychiatric domain had more modifications: The vascular event item included the sequelae of hemiparesis and hemiplegia, cranial neuropathy included sudden loss of hearing and cerebral venous thrombosis item were included. The post-infarction dementia item was reclassified including psychiatric disorders. The response rate after Delphi exercise was 95%. <h3>Conclusion:</h3> These scoping review demonstrate reproducibility of DIAPS, as well as its sensitivity to change, and specificity for thrombotic APS. DIAPSv2 is a new version of cumulative index damage was expanded and validated through a Panel Delphi exercise, which included a different participant. Neuropsychiatric domain was the one that had most modifications. DIAPSv2 is a revised index that can be their applied in various real scenarios as a useful tool in clinical and research areas. <h3>REFERENCES:</h3> [1] Amigo MC, et al. Development and Initial Validation of a Damage Index (DIAPS) in Patients. with Thrombotic Antiphospholipid Syndrome (APS) Lupus. 2015 Aug;24(9):927-34. [2] Goycochea MV 17º International Congress APS 2022. <h3>Acknowledgements:</h3> STUDY GROUP IN ANTIPHOSPHOLIPID SYNDROME MEXICAN COLLEGE OF RHEUMATOLOGY. <h3>Disclosure of Interests:</h3> None declared.