ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 731

Damage and Mortality in SLE: Cluster Analysis of Patients from SLE Registry from the Spanish Society for Rheumatology (RELESSER)

JM Pego-Reigosa1,2, Ana Lois-Iglesias3,4, Francisco Javier Lopez Longo5, María Galindo6, J Calvo-Alen7, Jacobo de Uña8, Vanessa Balboa9, Alejandro Olivé10, Coral Mouriño-Rodríguez1, Maria Teresa Oton Sanchez11, Jesus Ibañez12, Maria Loreto Horcada13, Ana Sánchez Atrio14, Carlos Alberto Montilla Morales15, Rafael-Benito Melero González1, Ricardo Blanco16, Elvira Diez Alvarez17, Monica Fernandez Castro18, Esther Ruiz Lucea19, José Hernández Beiraín20, Marian Gantes21, Blanca Hernández-Cruz22, Angela Pecondon-Español23, Nuria Lozano-Rivas24, Gema Bonilla25, Vicente Torrente-Segarra26, Iñigo Rúa-Figueroa27 and RELESSER EASSER Group, 1Rheumatology, EOXI Vigo, Vigo, Spain, 2Rheumatology, Instituto de Investigación Biomédica de Vigo(IBIV), Vigo, Spain, 3Rheumatology, Hospital Ntra Señora de La Esperanza, Santiago de Compostela, Spain, 4Rheumatology, University A Coruña, A Coruña, Spain, 5Servicio de Reumatologia, Hospital General Universitario Gregorio Marañón, Madrid, Spain, 6Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain, 7Rheumatology, Hospital de Sierrallana, Torrelavega, Spain, 8Statistics and OR, Vigo University, Vigo, Spain, 9Statistics and OR, Viho University, Vigo, Spain, 10Rheumatology, Hospital Germans Trias i Pujol, Badalona, Spain, 11Rheumatology, Hospital of Torrejón, Madrid, Spain, 12Rheumatology, Hospital Povisa, Vigo, Spain, 13Rheumatology, Complejo Hospitalario de Navarra, Pamplona, Spain, 14University Hospital Príncipe de Asturias, Immune System Diseases, Rheumatology department, Alcalá de Henares, Madrid, Spain, 15Rheumatology, Hospital Universitario de Salamanca, Salamanca, Spain, 16Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, 17Rheumatology, Hospital de León, León, Spain, 18Rheumatology, Hospital Puerta de Hierro, Madrid, Spain, 19Rheumatology, Hospital de Basurto, Bilbao, Spain, 20Rheumatology, Hospital Insular de Gran Canaria, Las palmas Gran Canarias, Spain, 21Rheumatology, Hospital Universitario de Canarias, La Laguna; Tenerife, Spain, 22Rheumatology, Hospital Universitario Virgen Macarena, Sevilla, Spain, 23Rheumatology, Hospital Miguel Servet, Zaragoza, Spain, 24Rheumatology, Hospital Virgen de la Arrixaca, Murcia, Spain, 25Rheumatology, Hospital La Paz - IdiPaz, Madrid, Spain, 26Hospital General Hospitalet-Sant Joan Despí Moisès Broggi, Hospitalet Llobregat, Barcelona, Spain, 27Rheumatology, Hospital Universitario Dr Negrín. Las Palmas, Las Palmas de Gran Canaria, Spain

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: ,

Session Information

Date: Sunday, November 8, 2015

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Damage in SLE is associated with mortality. Not every damage manifestation is associated in the same way. Some studies were made assessing this relation but in small and heterogeneous samples making difficult to obtain meaningful conclusions. Purpose:To evaluate patterns of damage accrual and mortality in a large sample of SLE patients.

Methods:

SLE patients from RELESSER were studied. After K-means cluster analysis, different clusters of patients with similar characteristics in terms of damage accrual were identified. Kaplan-Meier log-rank test and Cox regression were used to analyse mortality in each group.

Results:

3,656 SLE patients from 45 Rheumatology Units across Spain were studied. 90.33% were women. 93.15% were Caucasian, 5.21% Latinamerican and 1.64% other races. Mean age (±SD) at SLE diagnosis was 35.16±14.67 years. Mean follow-up time (±SD) was 120.19±87.67 months. Mean SLICC/ACR damage index (SDI) score was 1.15±1.67. Average number of organ systems affected in terms of damage was 0.65±1.06. 207 (5.66%) patients died.

The SDI organ systems most frequently damaged were: musculoskeletal(MS) (13.78%), ocular (8.51%), cardiovascular(CV)(7.99%) and renal (6.15%). The least frequently present were: gastrointestinal (1.96%), diabetes mellitus (2.41%) and premature gonadal failure (2.52%).

Three clusters (C) were formed. C1 had mild or no damage. All patients in C2 had MS damage but no CV. In C3 all patients had CV damage.

Among the 3 clusters, there were statistically significant differences (p<0.001) in the prevalence of damage in each organ system assessed by the SDI, in the average SDI score, in the number of SDI organ systems damaged and mortality rate. Comparative detailed data are shown in the table below.

In C3 patients were older at SLE diagnosis and had higher % of males, differences statistically significant between the 3 clusters for both variables (p<0.001).

Comparing survival curves of the 3 clusters, the log-rank test showed significant differences (p <0.001 for the triple and double comparisons). Analysing the survival rate at 10, 20 and 30 years from diagnosis of SLE, it was found lower survival in patients of C2 and C3 compared to C1 (p =0.068 when C2 is compared to C1 at 10 years, p<0.01 for all the other cases). Between C2 and C3, there were no significant differences in survival at 10 years and it was significantly lower in C3 at 20 and 30 years (p=0.025 for both).

Cox regression analysis showed that, compared with C1, the mortality hazard ratio of C2 and C3 was 1.9 and 3.5 higher respectively, being statistically significant, p<0.001 in both.

Conclusion:

SLE patients can be divided into different homogeneous groups (clusters) based on damage accrual. These clusters have different mortality rates.

Factors:

CLUSTER 1

n=2949 (80.66%)

CLUSTER 2

n=415 (11.35 %)

CLUSTER 3

N=292 (7.99%)

p-value

Damage:

Ocular

Neuropsychiatric

Renal

Pulmonary

Cardiovascular

Peripheral Vascular

Gastrointestinal

Musculoskeletal

Skin

Diabetes

Malignancy

Premature gonadal failure

171 (5.8)

123 (4.2)

132 (4.5)

58 (2.0)

0

88 (3.0)

44 (1.5)

0

56 (1.9)

56 (1.9)

114 (3.9)

48 (1.6)

76 (18.3)

47 (11.3)

36 (8.7)

33 (8.0)

0

37 (8.9)

15 (3.6)

415 (100)

35 (8.4)

12 (2.9)

38 (9.2)

28 (6.7)

64 (21.9)

51 (17.5)

57 (19.5)

41 (14.0)

292 (100)

38 (13.0)

12 (4.1)

89 (30.5)

33 (11.3)

20 (6.8)

18 (6.2)

16 (5.5)

<0.001

<0.001

<0.001

<0.001

<0.001

<0.001

<0.001

<0.001

<0.001

<0.001

<0.001

<0.001

Deads

102 (3.7)

45 (10.8)

60 (20.5)

<0.001

Damage

684 (23.2)

415 (100)

292 (100)

<0.001

Mean number of domains damaged

0.30 (± 0.62)

1.86 (±1.05)

2.50 (± 1.38)

<0.001

SLICC

0.68 (± 1.11)

2.60 (± 1.78)

3.82 (± 2.40)

<0.001

Age at SLE diagnosis

Gender

Male

Female

Race

Caucasian

Afroamerican

Latinoamerican

Asian/Oriental

Other

SLE duration

34.43 (± 14.07)

257 (8.7)

2686 (91.3)

2644 (92.4)

8 (0.3)

163 (5.7)

20 (0.7)

26 (0.9)

30.23 (± 51.30)

36.68 (± 15.75)

40 (9.7)

374 (90.3)

384 (95.8)

0

14 (3.5)

1 (0.2)

2 (.05)

35.27 (± 62.80)

40.26 (± 15.60)

56 (19.2)

236 (80.8)

279 (96.9)

0

8 (2.8)

0

1 (0.3)

32.76 (± 59.64)

<0.001

<0.001

0.0746

0.6420

Follow-up time

109.93 (± 81.29)

167.12 (± 98.95)

154.9 (± 100.17)

<0.001

Disclosure: J. Pego-Reigosa, Modest; Biocaps (grant 316265 ) of the 7th Framework Programme of the European Union ( FP7 / REGPOT - 2012-2013.1 ) ., FIS ( ISCIII ) PI11 / 02857. C. Other Research Support (supplies, equipment, receipt of drugs or other in-kind support); Modest; GSK , U, 2; A. Lois-Iglesias, None; F. J. Lopez Longo, None; M. Galindo, None; J. Calvo-Alen, None; J. de Uña, None; V. Balboa, None; A. Olivé, None; C. Mouriño-Rodríguez, None; M. T. Oton Sanchez, None; J. Ibañez, None; M. L. Horcada, None; A. Sánchez Atrio, None; C. A. Montilla Morales, None; R. B. Melero González, None; R. Blanco, None; E. Diez Alvarez, None; M. Fernandez Castro, None; E. Ruiz Lucea, None; J. Hernández Beiraín, None; M. Gantes, None; B. Hernández-Cruz, None; A. Pecondon-Español, None; N. Lozano-Rivas, None; G. Bonilla, None; V. Torrente-Segarra, None; I. Rúa-Figueroa, None.

To cite this abstract in AMA style:

Pego-Reigosa J, Lois-Iglesias A, Lopez Longo FJ, Galindo M, Calvo-Alen J, de Uña J, Balboa V, Olivé A, Mouriño-Rodríguez C, Oton Sanchez MT, Ibañez J, Horcada ML, Sánchez Atrio A, Montilla Morales CA, Melero González RB, Blanco R, Diez Alvarez E, Fernandez Castro M, Ruiz Lucea E, Hernández Beiraín J, Gantes M, Hernández-Cruz B, Pecondon-Español A, Lozano-Rivas N, Bonilla G, Torrente-Segarra V, Rúa-Figueroa I. Damage and Mortality in SLE: Cluster Analysis of Patients from SLE Registry from the Spanish Society for Rheumatology (RELESSER) [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/damage-and-mortality-in-sle-cluster-analysis-of-patients-from-sle-registry-from-the-spanish-society-for-rheumatology-relesser/. Accessed .

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