Hidradenitis Suppurativa: Proposal of Classification in Two Endotypes with Two-Step Cluster Analysis

Anxo González-Manso; Eugènia Agut-Busquet; Jorge Romaní; Eva Vilarrasa; Flavia Bittencourt; Anna Mensa; Elisabeth Cantó; Juan I. Aróstegui; Silvia Vidal

doi:10.1159/000511045

Hidradenitis Suppurativa: Proposal of Classification in Two Endotypes with Two-Step Cluster Analysis

Anxo González-Manso, Eugènia Agut-Busquet, Jorge Romaní^*, Eva Vilarrasa, Flavia Bittencourt, Anna Mensa, Elisabeth Cantó, Juan I. Aróstegui, Silvia Vidal

^*Autor corresponent d’aquest treball

Departament de Medicina

Producció científica: Contribució a revista › Article › Recerca › Avaluat per experts

36 Cites (Scopus)

Resum

Introducció: La hidradenitis supurativa (HS) és un trastorn crònic, inflamatori i recurrent de la unitat pilosebàcia. Actualment s'han fet diversos intents per classificar aquesta malaltia segons la seva patogènesi i manifestacions clíniques. Hem intentat classificar 103 pacients utilitzant una anàlisi d'agrupament en dues etapes. Mètodes: El model final incloïa l'índex de massa corporal, la proteïna C reactiva (CRP) i les concentracions sèriques d'IL-1, IL-6, IL-17 i IL-10 com a variables contínues, així com el sexe, inici precoç/tardà, llocs de lesions anteriors/posteriors, presència/absència de conductes sinusals, nòduls i abscessos, història positiva/negativa del si pilonidal i la presència/absència de mutacions en les subunitats gamma secretasa (APH1A, APH1B, MEFV, NCSTN, PSEN1, PSEN2, PSENEN, PSTPIP1) com a variables qualitatives. Resultats: El model resultant va definir dos grups o clústers: el grup 1 (64.9% dels pacients) es caracteritzava per homes no obesos amb lesions nodulars en llocs posteriors, HS d'inici precoç, concentracions més elevades d'IL-10, presència de mutacions gamma secretasa i història del si pilonidal; i el grup 2 (35.1% dels pacients) es caracteritzava per homes o dones obesos amb lesions anteriors, més presència de conductes sinusals i abscessos i menys nòduls, HS d'inici tardà i concentracions més elevades d'IL-1, CRP, IL-17 i IL-6. Les mesures de gravetat (Hurley, HS-PGA i IHS4) i l'ús del tabac es van descartar perquè l'anàlisi va trobar que eren menys rellevants per a la classificació en grups. Conclusió: El nostre model resultant confirma la impressió clínica que la HS és una malaltia amb un espectre de dues patologies que defineixen dos grups o endotips. La probabilitat de tenir una malaltia greu es distribuïa equitativament entre els dos grups. Les variables amb el valor predictiu més alt per a la classificació en grups era la implicació de llocs anteriors típics (aixelles, submamari) o posteriors atípics (esquena, gluti). Les concentracions sèriques d'interleucines, l'ús del tabac i el sexe tenien un poder predictiu menor per a la classificació.

Idioma original	Anglès
Pàgines (de-a)	365-371
Nombre de pàgines	7
Revista	Dermatology
Volum	237
Número	3
DOIs	https://doi.org/10.1159/000511045
Estat de la publicació	Publicada - d’abr. 2021

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Supplementary Material for: Hidradenitis Suppurativa: Proposal of Classification in Two Endotypes with Two-Step Cluster Analysis
González-Manso, A. (Creador), Agut-Busquet, E. (Creador), Romaní, J. (Creador), Vilarrasa, E. (Creador), Bittencourt, F. (Creador), Mensa, A. (Creador), Cantó, E. (Creador), Aróstegui, J. I. (Creador) & Vidal, S. (Creador), 10 de nov. 2020
DOI: 10.6084/m9.figshare.13213550.v1, https://karger.figshare.com/articles/dataset/Supplementary_Material_for_Hidradenitis_Suppurativa_Proposal_of_Classification_in_Two_Endotypes_with_Two-Step_Cluster_Analysis/13213550/1
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title = "Hidradenitis Suppurativa: Proposal of Classification in Two Endotypes with Two-Step Cluster Analysis",

abstract = "Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent disorder of the pilosebaceous unit. Currently, several attempts have been made to classify this disease according to its pathogenesis and clinical manifestations. We attempted at classifying 103 patients using two-step cluster analysis. Methods: The final model included body mass index, C-reactive protein (CRP), and serum concentrations of IL-1, IL-6, IL-17, and IL-10 as continuous variables, and sex, later/early onset, anterior/posterior lesion sites, presence/absence of sinus tracts, nodules and abscesses, positive/negative history of pilonidal sinus, and presence/absence of mutations in gamma-secretase subunits (APH1A, APH1B, MEFV, NCSTN, PSEN1, PSEN2, PSENEN, PSTPIP1) as qualitative variables. Results: The resultant model defined two groupings or clusters: cluster 1 (64.9\% of patients) characterized by nonobese males, with nodular lesions in posterior sites, early-onset HS, higher IL-10, presence of gamma-secretase mutations, and history of pilonidal sinus; and cluster 2 (35.1\% of patients) characterized by obese females or males, with lesions in anterior sites, more presence of sinus tracts and abscesses and less nodules, later-onset HS, and higher concentrations of IL-1, CRP, IL-17, and IL-6. Severity measures (Hurley, HS-PGA, and IHS4) and tobacco use were discarded because the analysis found them to be less relevant for clustering. Conclusion: Our resultant model confirms the clinical impression that HS is a disease spectrum with two pathogenic poles defining two clusters or endotypes. The probability of having severe disease was equally distributed in the two clusters. The variable with the highest predictive value for clustering was involvement of typical anterior sites (axillae, submammary) or atypical posterior sites (back, gluteal). Serum concentrations of interleukins, tobacco use, and sex had a lower predictive power for clustering.",

keywords = "Endotypes, Hidradenitis suppurativa, Phenotypes",

author = "Anxo Gonz{\'a}lez-Manso and Eug{\`e}nia Agut-Busquet and Jorge Roman{\'i} and Eva Vilarrasa and Flavia Bittencourt and Anna Mensa and Elisabeth Cant{\'o} and Ar{\'o}stegui, \{Juan I.\} and Silvia Vidal",

note = "Publisher Copyright: {\textcopyright} 2020 ",

year = "2021",

month = apr,

doi = "10.1159/000511045",

language = "English",

volume = "237",

pages = "365--371",

journal = "Dermatology",

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T1 - Hidradenitis Suppurativa

T2 - Proposal of Classification in Two Endotypes with Two-Step Cluster Analysis

AU - González-Manso, Anxo

AU - Agut-Busquet, Eugènia

AU - Romaní, Jorge

AU - Vilarrasa, Eva

AU - Bittencourt, Flavia

AU - Mensa, Anna

AU - Cantó, Elisabeth

AU - Aróstegui, Juan I.

AU - Vidal, Silvia

PY - 2021/4

Y1 - 2021/4

N2 - Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent disorder of the pilosebaceous unit. Currently, several attempts have been made to classify this disease according to its pathogenesis and clinical manifestations. We attempted at classifying 103 patients using two-step cluster analysis. Methods: The final model included body mass index, C-reactive protein (CRP), and serum concentrations of IL-1, IL-6, IL-17, and IL-10 as continuous variables, and sex, later/early onset, anterior/posterior lesion sites, presence/absence of sinus tracts, nodules and abscesses, positive/negative history of pilonidal sinus, and presence/absence of mutations in gamma-secretase subunits (APH1A, APH1B, MEFV, NCSTN, PSEN1, PSEN2, PSENEN, PSTPIP1) as qualitative variables. Results: The resultant model defined two groupings or clusters: cluster 1 (64.9% of patients) characterized by nonobese males, with nodular lesions in posterior sites, early-onset HS, higher IL-10, presence of gamma-secretase mutations, and history of pilonidal sinus; and cluster 2 (35.1% of patients) characterized by obese females or males, with lesions in anterior sites, more presence of sinus tracts and abscesses and less nodules, later-onset HS, and higher concentrations of IL-1, CRP, IL-17, and IL-6. Severity measures (Hurley, HS-PGA, and IHS4) and tobacco use were discarded because the analysis found them to be less relevant for clustering. Conclusion: Our resultant model confirms the clinical impression that HS is a disease spectrum with two pathogenic poles defining two clusters or endotypes. The probability of having severe disease was equally distributed in the two clusters. The variable with the highest predictive value for clustering was involvement of typical anterior sites (axillae, submammary) or atypical posterior sites (back, gluteal). Serum concentrations of interleukins, tobacco use, and sex had a lower predictive power for clustering.

AB - Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent disorder of the pilosebaceous unit. Currently, several attempts have been made to classify this disease according to its pathogenesis and clinical manifestations. We attempted at classifying 103 patients using two-step cluster analysis. Methods: The final model included body mass index, C-reactive protein (CRP), and serum concentrations of IL-1, IL-6, IL-17, and IL-10 as continuous variables, and sex, later/early onset, anterior/posterior lesion sites, presence/absence of sinus tracts, nodules and abscesses, positive/negative history of pilonidal sinus, and presence/absence of mutations in gamma-secretase subunits (APH1A, APH1B, MEFV, NCSTN, PSEN1, PSEN2, PSENEN, PSTPIP1) as qualitative variables. Results: The resultant model defined two groupings or clusters: cluster 1 (64.9% of patients) characterized by nonobese males, with nodular lesions in posterior sites, early-onset HS, higher IL-10, presence of gamma-secretase mutations, and history of pilonidal sinus; and cluster 2 (35.1% of patients) characterized by obese females or males, with lesions in anterior sites, more presence of sinus tracts and abscesses and less nodules, later-onset HS, and higher concentrations of IL-1, CRP, IL-17, and IL-6. Severity measures (Hurley, HS-PGA, and IHS4) and tobacco use were discarded because the analysis found them to be less relevant for clustering. Conclusion: Our resultant model confirms the clinical impression that HS is a disease spectrum with two pathogenic poles defining two clusters or endotypes. The probability of having severe disease was equally distributed in the two clusters. The variable with the highest predictive value for clustering was involvement of typical anterior sites (axillae, submammary) or atypical posterior sites (back, gluteal). Serum concentrations of interleukins, tobacco use, and sex had a lower predictive power for clustering.

KW - Endotypes

KW - Hidradenitis suppurativa

KW - Phenotypes

UR - https://www.scopus.com/pages/publications/85096104466

U2 - 10.1159/000511045

DO - 10.1159/000511045

M3 - Article

C2 - 33171462

AN - SCOPUS:85096104466

SN - 1018-8665

VL - 237

SP - 365

EP - 371

JO - Dermatology

JF - Dermatology

IS - 3

ER -

Hidradenitis Suppurativa: Proposal of Classification in Two Endotypes with Two-Step Cluster Analysis

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Supplementary Material for: Hidradenitis Suppurativa: Proposal of Classification in Two Endotypes with Two-Step Cluster Analysis

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