title: 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.
abstract: To identify patterns (clusters) of damage manifestations within a large cohort of SLE patients and evaluate the potential association of these clusters with a higher risk of mortality.
  
  
  
  This is a multicentre, descriptive, cross-sectional study of a cohort of 3656 SLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestations were identified. Then, overall clusters were compared as well as the subgroup of patients within every cluster with disease duration shorter than 5 years.
  
  
  
  Three damage clusters were identified. Cluster 1 (80.6% of patients) presented a lower amount of individuals with damage (23.2 vs 100% in clusters 2 and 3, P < 0.001). Cluster 2 (11.4% of patients) was characterized by musculoskeletal damage in all patients. Cluster 3 (8.0% of patients) was the only group with cardiovascular damage, and this was present in all patients. The overall mortality rate of patients in clusters 2 and 3 was higher than that in cluster 1 (P < 0.001 for both comparisons) and in patients with disease duration shorter than 5 years as well.
  
  
  
  In a large cohort of SLE patients, cardiovascular and musculoskeletal damage manifestations were the two dominant forms of damage to sort patients into clinically meaningful clusters. Both in early and late stages of the disease, there was a significant association of these clusters with an increased risk of mortality. Physicians should pay special attention to the early prevention of damage in these two systems.
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: José María
authors.initials: JM
authors.lastname: Pego-Reigosa
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Ana
authors.initials: A
authors.lastname: Lois-Iglesias
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Íñigo
authors.initials: Í
authors.lastname: Rúa-Figueroa
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: María
authors.initials: M
authors.lastname: Galindo
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Jaime
authors.initials: J
authors.lastname: Calvo-Alén
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Jacobo
authors.initials: J
authors.lastname: de Uña-Álvarez
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Balboa-Barreiro
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Jesús
authors.initials: J
authors.lastname: Ibáñez Ruan
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Olivé
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez-Gómez
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández Nebro
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Mariano
authors.initials: M
authors.lastname: Andrés
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Celia
authors.initials: C
authors.lastname: Erausquin
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Eva
authors.initials: E
authors.lastname: Tomero
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Loreto
authors.initials: L
authors.lastname: Horcada Rubio
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Esther
authors.initials: E
authors.lastname: Uriarte Isacelaya
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Freire
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Carlos
authors.initials: C
authors.lastname: Montilla
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Sánchez-Atrio
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Santos-Soler
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Antonio
authors.initials: A
authors.lastname: Zea
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Elvira
authors.initials: E
authors.lastname: Díez
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Javier
authors.initials: J
authors.lastname: Narváez
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco-Alonso
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Lucía
authors.initials: L
authors.lastname: Silva-Fernández
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: María Esther
authors.initials: ME
authors.lastname: Ruiz-Lucea
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Mónica
authors.initials: M
authors.lastname: Fernández-Castro
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: José Ángel
authors.initials: JÁ
authors.lastname: Hernández-Beriain
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Marian
authors.initials: M
authors.lastname: Gantes-Mora
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Blanca
authors.initials: B
authors.lastname: Hernández-Cruz
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: José
authors.initials: J
authors.lastname: Pérez-Venegas
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Pecondón-Español
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Carlos
authors.initials: C
authors.lastname: Marras Fernández-Cid
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Mónica
authors.initials: M
authors.lastname: Ibáñez-Barcelo
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Gema
authors.initials: G
authors.lastname: Bonilla
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Vicenç
authors.initials: V
authors.lastname: Torrente-Segarra
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Iván
authors.initials: I
authors.lastname: Castellví
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Alegre
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Joan
authors.initials: J
authors.lastname: Calvet
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo jose.maria.pego.reigosa@sergas.es.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Marenco de la Fuente
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Enrique
authors.initials: E
authors.lastname: Raya
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Tomás Ramón
authors.initials: TR
authors.lastname: Vázquez-Rodríguez
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Víctor
authors.initials: V
authors.lastname: Quevedo-Vila
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Santiago
authors.initials: S
authors.lastname: Muñoz-Fernández
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Teresa
authors.initials: T
authors.lastname: Otón
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Anisur
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Rheumatology Department, University Hospital Complex of Vigo.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: López-Longo
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000209:etiology / Q000401:mortality*; D012042:Registries; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors
keywords: RELESSER; Spanish; cluster analysis; cohort; mortality; organ damage; systemic lupus erythematosus