PREGNA-RISK: Composite Pregnancy Risk Score for SLE/APS with Monte Carlo Uncertainty Estimation
We describe a weighted composite score for pregnancy risk stratification in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). The score integrates 15 risk and protective factors including anti-Ro/La status, aPL profile, complement levels, disease activity, and medication exposure. Weights were assigned based on published literature (Buyon 2015 PROMISSE, Clowse 2006, Andreoli 2017) rather than derived from patient data. Monte Carlo simulation (1000 iterations) propagates uncertainty in input categorization to produce risk distributions rather than point estimates. The score has not been validated in a clinical cohort. We report the algorithm, weight rationale, and simulation methodology.
PREGNA-RISK
Algorithm
15 weighted binary/categorical inputs covering anti-Ro/La, aPL triple positivity, complement, lupus nephritis, prior adverse pregnancy outcome, disease activity (SLEDAI), medication risk, and protective factors (HCQ, low-dose aspirin, LMWH).
Weight Source
Published literature, not patient-derived data: Buyon 2015 (PROMISSE), Clowse 2006, Andreoli 2017 EULAR recommendations.
Monte Carlo
1000 iterations with jittered input categorization to produce risk distributions.
Limitations
- Not validated in a clinical cohort
- Weights from literature review, not regression analysis
- Does not replace clinical judgment
References
- Buyon JP et al. Arthritis Rheumatol 2015;67:2376-85 (PROMISSE)
- Clowse MEB et al. Arthritis Rheum 2006;54:3640-7
- Andreoli L et al. Ann Rheum Dis 2017;76:476-85
Authors
Zamora-Tehozol EA (ORCID:0000-0002-7888-3961), DNAI
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