Identifying phenotypes of patients with antiphospholipid antibodies: results from a cluster analysis in a large cohort of patients. (16th December 2019)

• Record Type: Journal Article
• Authors: Sciascia, Savino; Radin, Massimo; Cecchi, Irene; Bertolaccini, Maria Laura; Bertero, Maria Tiziana; Rubini, Elena; Vaccarino, Antonella; Bazzan, Mario; Giachino, Osvaldo; Baldovino, Simone; Rossi, Daniela; Mengozzi, Giulio; Roccatello, Dario
• Is Part Of: Rheumatology. Volume 60:Number 3(2021)
• Page Start: 1106
• Page End: 1113
• Publication Date: 2019-12-16
• Subjects: antiphospholipid antibodies -- antiphospholipid syndrome -- thrombosis -- systemic lupus erythematosus; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/kez596
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objectives: To identify the aggregation of patients with aPL into different subgroups sharing common features in terms of clinical and laboratory phenotypes. Methods: We applied a hierarchical cluster analysis from the multiple correspondence analysis to determine subgroups of patients according to clinical and laboratory characteristics in a cohort of subjects with confirmed aPL positivity who presented to our outpatient clinics from 2006 to 2018. Results: A total of 486 patients [403 women; age 41.7 years (26)] were included, resulting in five clusters. Cluster 1 ( n = 150) presented with thrombotic events (65.3% with venous thrombosis), with triple aPL positivity found in 34.7% of them (the highest rate among the different clusters). All the patients from cluster 2 ( n = 91) had a confirmed diagnosis of SLE and the highest rate of anti-dsDNA positivity (91.7%). Cluster 3 included 79 women with pregnancy morbidity. Triple positivity was present in 3.8%, significantly lower when compared with Cluster 1 (34.7% versus 3.8%, P <0.01). Cluster 4 included 67 patients, 28 (41.8%) of whom with APS. Thrombotic events were observed in 23.9% patients. Cluster 4 had the highest rate of cytopenia, with thrombocytopenia as high 41.8% with no anti-dsDNA antibodies. Cluster 5 included 94 asymptomatic aPL carriers. Conclusion: While clusters 1, 2, 3 and 5 corresponded to well-known entities, cluster 4 might represent a bridging condition between pure primary APS and defined SLE, with lower thrombotic risk when compared with primary APS but higher general features such as ANA and cytopenia (mainly thrombocytopenia).