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

JM Pego-Reigosa^1,2, Ana Lois-Iglesias^3,4, 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: Disease Activity, SLE and morbidity and mortality

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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