Evidence map›Paper›PMID 40958002›Full record

ArticleImmunologic research2025

Optimizing antiphospholipid antibody testing: a real-world analysis of appropriateness and resource utilization.

Silvia Grazietta Foddai, Maria Infantino, Mariangela Manfredi, Francesca Pavia, Maurizio Benucci, Francesca Li Gobbi, Massimo Radin, Irene Cecchi, Alice Barinotti, Savino Sciascia

Abstract read
In one paragraph

Article in Immunologic research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Silvia Grazietta FoddaiUniversity Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERKNet, ERN-Reconnet and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Turin, 10154, Italy.
Maria InfantinoImmunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Florence, Italy.
Mariangela ManfrediImmunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Florence, Italy.
Francesca PaviaImmunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Florence, Italy.
Maurizio BenucciRheumatology Unit, S. Giovanni di Dio Hospital, Florence, Italy.
Francesca Li GobbiRheumatology Unit, S. Giovanni di Dio Hospital, Florence, Italy.
Massimo RadinUniversity Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERKNet, ERN-Reconnet and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Turin, 10154, Italy.
Irene CecchiUniversity Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERKNet, ERN-Reconnet and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Turin, 10154, Italy.
Alice BarinottiUniversity Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERKNet, ERN-Reconnet and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Turin, 10154, Italy.
Savino SciasciaUniversity Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERKNet, ERN-Reconnet and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Turin, 10154, Italy. savino.sciascia@unito.it.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Efficient utilization of healthcare resources, including laboratory testing, is crucial for environmental sustainability and cost-effectiveness. The diagnosis of APS requires the presence of at least one clinical event (either an objectively confirmed thrombotic event and/or pregnancy complication) and detection of one or more aPL (lupus anticoagulant [LA], IgG/IgM anticardiolipin [aCL], and/or IgG/IgM anti-β2 glycoprotein-1 [aβ2GPI]). However, inappropriate requests for aPL tests contribute to unnecessary healthcare expenses and environmental impact. This study evaluates the appropriateness of aPL testing in a clinical setting. A retrospective analysis was conducted on 642 patients attending the San Giovanni Di Dio Hospital, Florence (11/2023-02/2024). Diagnostic suspicion underlying aPL test requests were classified as appropriate, inappropriate, or unevaluable using a scoring system based on clinical recommendations. Appropriateness assessment was performed independently by two researchers and reconciled with a third expert. Patient demographics, test results, and the specialty of the physicians ordering aPL were recorded and analyzed. Of the 642 queries, 36% were deemed appropriate, 42% inappropriate, and 22% unevaluable. Family physicians accounted for 53% of all test requests but exhibited the highest rate of inappropriate requests (44%). Rheumatologists, internal medicine physicians, and gynecologists demonstrated better adherence to recommendations (with 34%, 30%, and 18% of inappropriate requests, respectively). Only 4.9% of patients underwent comprehensive aPL testing per international standards (Sidney criteria). Among the 115 aPL-positive cases, multiple antibody positivity was more common in appropriate test requests. Inappropriate requests often stemmed from conditions without established links to APS, such as alopecia, hypercholesterolemia, and dysmenorrhea. A considerable proportion of aPL testing in routine practice lacks clinical justification, reflecting variability in guideline adherence across specialties. Inappropriate testing increases healthcare costs, specialist referrals, and environmental burdens. Improved education, adherence to diagnostic recommendations, and sustainable practices are critical to optimizing APS testing and resource utilization.

Indexed as

Antibodies, AntiphospholipidAntiphospholipid SyndromeAdultAgedFemaleHealth ResourcesHumansMaleMiddle AgedRetrospective StudiesAntibodies, AntiphospholipidAPL antibodiesAppropriatenessClinical queries

Identifiers

PMID40958002
PMCPMC12441101

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.