BACKGROUND@#
Antiphospholipid syndrome (APS) is an autoimmune prothrombotic condition with significant
morbidity . The objective of this study was to identify additional clinical and epidemiological
risks of arterial
thrombosis, venous thrombosis , and
pregnancy morbidities in a large cohort of persistent
antiphospholipid antibodies (aPLs)-positive carriers.@*
METHODS @#This was a cross-sectional
cohort study of 453 consecutive
patients with a documented positive aPL
who attended
Peking University People's
Hospital . Among 453
patients screened, 297
patients had persistent positive aPL. We compared asymptomatic aPL carriers with thrombotic and obstetric APS
patients . And the univariate
analysis and multivariable
logistic regression were used to evaluate the
association between different
risk factors and APS clinical manifestations. The levels of circulating markers of
neutrophil extracellular traps (NETs) (
cell-free DNA and citrullinated
histone H3 [Cit-H3]) were assessed and compared among aPL-positive carriers with or without
autoimmune disease and APS
patients .@*RESULTS@#Additional
risk factors associated with arterial
thrombosis among aPL-positive carriers included
smoking (
odds ratio [OR] = 6.137, 95%
confidence interval [CI] = 2.408-15.637, P = 0.0001),
hypertension (OR = 2.368, 95% CI = 1.249-4.491, P = 0.008), and the presence of underlying
autoimmune disease (OR = 4.401, 95% CI = 2.387-8.113, P < 0.001). Additional
risks associated with
venous thrombosis among aPL carriers included
smoking (OR = 4.594, 95% CI = 1.681-12.553, P = 0.029) and the presence of underlying
autoimmune disease (OR = 6.330, 95% CI = 3.355-11.940, P < 0.001). The presence of underlying
autoimmune disease (OR = 3.301, 95% CI = 1.407-7.744, P = 0.006) is the additional
risk , which demonstrated a significant
association with APS
pregnancy morbidity . Higher circulating levels of
cell-free DNA and Cit-H3 were observed among APS
patients and aPL
patients with
autoimmune diseases compared with those aPL carriers without underlying
autoimmune diseases . Furthermore, control
neutrophils that are conditioned with APS
patients 'sera have more pronounced NET release compared with those treated with aPL carriers'sera without underlying
autoimmune diseases .@*CONCLUSIONS@#We identified several potential additional
risk factors for APS clinical manifestations among a large cohort of
Chinese aPL carriers. Our data may help
physicians to
risk stratify aPL-positive
Asian patients .