Rheumatology (Oxford, England) · 2026
Nailfold capillaroscopy improves cardiovascular risk stratification in SSc: an adjustment of the SCORE2 algorithm.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Valera-Ribera Carlos, Alegre-Sancho Juan José, González-Gay Miguel Ángel, Lacasa-Molina Joaquín, Taberner-Cortés Alida, Robustillo-Villarino Montserrat, Narváez Javier
Аннотация
OBJECTIVE: SSc is characterized by micro- and macrovascular damage, increasing cardiovascular (CV) risk. The SCORE2 algorithm underestimates CV risk in systemic autoimmune diseases. Nailfold capillaroscopy (NFC) is used to assess SSc-related microvascular damage. We aimed to evaluate whether incorporating NFC findings into SCORE2/SCORE2-OP improves CV risk stratification in SSc.
METHODS: Retrospective multicentre study including 276 patients with SSc. Baseline 10-year CV risk was estimated using SCORE2 or SCORE2-OP. NFC at diagnosis was assessed. Cox regression identified NFC variables associated with major CV events (MCEs). Their adjusted hazard ratios (HRs) were applied to derive NFC-modified SCORE2 models. Discrimination, calibration and reclassification of original vs modified models were compared, with bootstrap internal validation.
RESULTS: Over a median follow-up of 9.5 years, 45 (16.3%) patients experienced an MCE. In multivariable models, late NFC pattern (HR 4.056, P = 0.002) and avascular areas (HR 2.631, P = 0.039) were independently associated with MCEs, whereas microhaemorrhages were associated with reduced risk (HR 0.345, P = 0.017). Original SCORE2 showed modest discrimination for incident MCEs (AUC 0.687, 95% CI 0.574-0.801). NFC-modified models improved discrimination (AUC 0.784, 95% CI 0.674-0.894 for the NFC-findings model and 0.764, 95% CI 0.654-0.875 for the NFC-pattern model; both P < 0.05 vs SCORE2), with consistent gains in Harrell's C-index. Risk reclassification analyses showed classification of patients with MCEs, with categorical net reclassification indices of 0.31 and 0.36, respectively.
CONCLUSIONS: Incorporating baseline NFC into SCORE2 improves CV stratification in patients with SSc, and may support more individualized CV prevention strategies in SSc.
METHODS: Retrospective multicentre study including 276 patients with SSc. Baseline 10-year CV risk was estimated using SCORE2 or SCORE2-OP. NFC at diagnosis was assessed. Cox regression identified NFC variables associated with major CV events (MCEs). Their adjusted hazard ratios (HRs) were applied to derive NFC-modified SCORE2 models. Discrimination, calibration and reclassification of original vs modified models were compared, with bootstrap internal validation.
RESULTS: Over a median follow-up of 9.5 years, 45 (16.3%) patients experienced an MCE. In multivariable models, late NFC pattern (HR 4.056, P = 0.002) and avascular areas (HR 2.631, P = 0.039) were independently associated with MCEs, whereas microhaemorrhages were associated with reduced risk (HR 0.345, P = 0.017). Original SCORE2 showed modest discrimination for incident MCEs (AUC 0.687, 95% CI 0.574-0.801). NFC-modified models improved discrimination (AUC 0.784, 95% CI 0.674-0.894 for the NFC-findings model and 0.764, 95% CI 0.654-0.875 for the NFC-pattern model; both P < 0.05 vs SCORE2), with consistent gains in Harrell's C-index. Risk reclassification analyses showed classification of patients with MCEs, with categorical net reclassification indices of 0.31 and 0.36, respectively.
CONCLUSIONS: Incorporating baseline NFC into SCORE2 improves CV stratification in patients with SSc, and may support more individualized CV prevention strategies in SSc.