Relationship between damage clustering and mortality in systemic lupus erythematosus in early and late stages of the disease: cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry

Pego-Reigosa, José María; Iglesias, Ana; Rúa-Figueroa, Íñigo; Galindo, María; Calvo‐Alén, Jaime; Uña‐Álvarez, Jacobo de; Balboa‐Barreiro, Vanesa; Ruán, Jesús Ibáñez; Olivé, Alejandro; Rodríguez–Gómez, Manuel; Nebro, Antonio Fernández; Andrés, Mariano; Erausquin, Celia; Tomero, Eva; Rubio, Loreto Horcada; Isacelaya, Esther Uriarte; Freire, Mercedes; Montilla, Carlos; Sánchez-Atrio, Ana; Santos-Soler, G.; Zea, Antonio; Díez, E.; Narváez, Javier; Blanco, Ricardo; Silva-Fernández, Lucía; Ruiz-Lucea, María Esther; Fernández‐Castro, Mónica; Hernández‐Beriain, José Ángel; Gantes-Mora, Marian; Hernández‐Cruz, Blanca; Pérez-Venegas, J.J.; Pecondón-Español, Ángela; Marras, Carlos; Ibáñez‐Barceló, Mónica; Bonilla, Gema; Torrente-Segarra, Vicenç; Castellví, Iván; Alegre, J.J.; Calvet, Joan; Fuente, José Luís Marenco de la; Raya, Enrique; Vázquez-Rodríguez, Tomás R.; Quevedo-Vila, Víctor; Muñóz-Fernández, Santiago; Otón, Teresa; Rahman, Anisur; López‐Longo, Francisco Javier

doi:10.1093/rheumatology/kew049

Cited by 30 publications

(36 citation statements)

References 22 publications

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“…In the largest cluster, representing 73% of those analyzed (cluster 1), patients had little organ damage, thus corroborating previous SLE cohort studies . For instance, Pego‐Reigosa et al classified 3656 Spanish adults with SLE in the Spanish Rheumatology Society Lupus Registry (RELESSER) cohort into three damage clusters in 2015, and 2949 (80.6%) of them were assigned to the cluster showing the least damage. Toreente‐Segarra et al performed cluster analysis on 345 juvenile patients with SLE in the same cohort, finding that 72.7% of the patients were assigned to the cluster with least damage.…”

Section: Discussionsupporting

confidence: 75%

“…However, there were differences in patient selection between these three studies. Pego‐Reigosa et al recruited patients >16 years old, while Toreente‐Segarra et al recruited juvenile patients . We excluded patients with SLE whose disease duration was <5 years.…”

Section: Discussionmentioning

confidence: 99%

“…However, predicting disease course and outcomes is difficult because SLE is heterogeneous; therefore considerable effort has been devoted to identifying disease subtypes . To date, many studies have attempted to distinguish such subtypes on the basis of cytokine levels, human leukocyte antigen (HLA)‐DRB1 alleles, and autoantibody clusters, but few have investigated phenotypic subclusters …”

Section: Introductionmentioning

confidence: 99%

“…Previous investigations into organ damage associated with SLE have typically compared patients according to the presence or absence of certain damage domains; alternatively they have investigated factors associated with damage accrual or the impact of damage on survival . Few studies have identified subphenotyes by identifying patterns of organ damage and relating them to organ damage, disease activity, mortality, and genetic background. The objective of the present study was to identify phenotypic clusters within a cohort of patients with SLE, and to compare their clinical manifestations, mortality, and genetic risk scores (GRS).…”

Section: Introductionmentioning

confidence: 99%

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Identifying damage clusters in patients with systemic lupus erythematosus

Ahn

Lee²,

Won³

et al. 2019

Int J of Rheum Dis

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Aim Systemic lupus erythematosus (SLE) causes irreversible damage to organ systems. Recently, evidence has been obtained for subphenotypes of SLE. This study aimed to identify damage clusters and compare the associated clinical manifestations, SLE disease activity, mortality, and genetic risk scores (GRS). Methods The study was conducted on the Hanyang BAE lupus cohort. Patients with disease duration <5 years were excluded to minimize confounding effects of disease duration. They were grouped into 3 clusters based on the Systemic Lupus International Collaborating Clinics Damage Index using k‐means cluster analysis. Results Among the 1130 analyzed patients, musculoskeletal damage was most prevalent (20.2%), followed by ocular (11.4%), renal (10.5%), and neuropsychiatric damage (10.2%). Three significantly different damage clusters were identified. Patients in cluster 1 (n = 824) showed the least damage. Cluster 2 (n = 195) was characterized by frequent renal (55.4%) and ocular (58.0%) damage, and cluster 3 (n = 111) was dominated by neuropsychiatric (100%) and musculoskeletal damage (35.1%). Cluster 2 had the highest adjusted mean AMS (adjusted mean SLE Disease Activity Index score; mean ± SD: 5.4 ± 2.9), while cluster 3 had the highest mortality (14.4%). Weighted GRS did not differ significantly between the clusters. Conclusion Patients in prevalent renal and ocular damage cluster had the highest AMS scores, while the cluster with frequent neuropsychiatric damage had the highest mortality.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Identifying damage clusters in patients with systemic lupus erythematosus

Ahn

Lee²,

Won³

et al. 2019

Int J of Rheum Dis

View full text Add to dashboard Cite

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“…Among these, thrombosis is a well‐defined and important clinical complication in SLE . In particular, cerebral and cardiovascular ischemic events are major causes of irreversible damage and death in patients with SLE . Previous studies have found that the probability of arterial ischemic events is 5.1%‐8.5% within 5 years of diagnosis in patients with SLE .…”

Section: Discussionmentioning

confidence: 99%

Evaluating hypercoagulability in new‐onset systemic lupus erythematosus patients using thromboelastography

Gong

Shi

Zhou

et al. 2019

Clinical Laboratory Analysis

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Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease that involves T cell, B cell, and dendritic cell dysfunction, as well as antinuclear autoantibody production. 1 Several clinical and scientific studies of SLE indicate an increased risk of thrombosis in these cases. [2][3][4][5] Moreover, patients with SLE may exhibit accelerated atherosclerosis, and higher cardiovascular morbidity and mortality. 6The traditional parameters for screening coagulopathy include prothrombin time (PT) and activated partial thromboplastin time (aPTT). However, in Owaidah's study, among patients with positive lupus anticoagulant (LAC) status, 61% exhibited abnormal aPTT results that could not be corrected by mixing with normal plasma; moreover, the PT test yielded normal results in 90% cases. 7 However, there is a limitation of the aPTT and PT test in these cases, as the results may reflect a certain product in the coagulation process, rather than the actual marker they are intended to reflect. Moreover, SLE Abstract Background: Thromboelastography (TEG) can reflect the coagulation status in vivo, from clot formation to clot lysis. In the present study, we aimed to evaluate the function of TEG in detecting coagulation in patients with SLE and sought to explore the correlation between clinical and laboratory data. Methods:A total of 41 patients with new-onset SLE who had not undergone treatment and 56 healthy controls were included. TEG and other laboratory tests were performed, and clinical data were collected.Results: A significant difference in the TEG reaction time and TEG achievement of clot firmness was observed between the groups. Moreover, these parameters were correlated with the lupus anticoagulant levels, platelet count, 24-hour urinary total protein quantity, and systemic lupus erythematosus disease activity index. Conclusion:Our study demonstrated the prospective value of TEG in evaluating hypercoagulability in patients with SLE.

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Direct modeling of regression effects for transition probabilities in the progressive illness-death model

2017

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In this work, we present direct regression analysis for the transition probabilities in the possibly non-Markov progressive illness-death model. The method is based on binomial regression, where the response is the indicator of the occupancy for the given state along time. Randomly weighted score equations that are able to remove the bias due to censoring are introduced. By solving these equations, one can estimate the possibly time-varying regression coefficients, which have an immediate interpretation as covariate effects on the transition probabilities. The performance of the proposed estimator is investigated through simulations. We apply the method to data from the Registry of Systematic Lupus Erythematosus RELESSER, a multicenter registry created by the Spanish Society of Rheumatology. Specifically, we investigate the effect of age at Lupus diagnosis, sex, and ethnicity on the probability of damage and death along time. Copyright © 2017 John Wiley & Sons, Ltd.

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Relationship between damage clustering and mortality in systemic lupus erythematosus in early and late stages of the disease: cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry

Cited by 30 publications

References 22 publications

Identifying damage clusters in patients with systemic lupus erythematosus

Identifying damage clusters in patients with systemic lupus erythematosus

Evaluating hypercoagulability in new‐onset systemic lupus erythematosus patients using thromboelastography

Direct modeling of regression effects for transition probabilities in the progressive illness-death model

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