Lupus & antiphospholipid syndrome
Classification performance of the 2023 ACR/EULAR antiphospholipid syndrome criteria: a systematic review and meta-analysis
Authors' conclusion
The 2023 ACR/EULAR APS classification criteria exhibit consistently excellent specificity but reduced and phenotype-dependent sensitivity.
Study context
- Population
- Studies (August 2023 through May 2026) evaluating the 2023 ACR/EULAR antiphospholipid syndrome (APS) criteria in patients previously classified by expert diagnosis and/or 2006 revised Sapporo (Sydney) criteria; 13 with non-APS control groups24 studies · 25 data sets
- Comparison
- 2023 ACR/EULAR APS classification criteria vs expert clinical diagnosis and/or 2006 revised Sapporo (Sydney) criteria
- Outcome
- Classification performance (pooled sensitivity and specificity) of the 2023 ACR/EULAR APS criteria
Methodological detailsbivariate random-effects model, univariate random-effects model (sensitivity)
- Bivariate random-effects model
- Univariate random-effects model (sensitivity)
Pooled result
As reported in the abstract
Classification performance of the 2023 ACR/EULAR APS criteria, bivariate meta-analysis
Pooled sensitivity
0.74
95% CI 0.67–0.81
Pooled specificity
0.99
95% CI 0.98–1.00
Further pooled results
Sensitivity by APS phenotype (subgroups)
- Pooled sensitivity, studies restricted to obstetric APS
- 0.20
- Pooled sensitivity, obstetric APS incl. obstetric subgroup data from additional studies
- 0.31
- Sensitivity, thrombotic APS
- 0.82
Drivers of non-classification
- Non-classification mainly driven by isolated IgM aPL positivity and obstetric APS phenotypes
Original publication
Classification performance of the 2023 ACR/EULAR antiphospholipid syndrome criteria: a systematic review and meta-analysis. Rheumatology (Oxford). Published 19 August 2026. doi:10.
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