Stroke in patients with SLE associated with poorer outcomes and higher mortality and recurrence rates

Patients with vs without systemic lupus erythematosus (SLE) who experience a stroke have poorer short-term functional outcomes and higher mortality and recurrence rates, according to an analysis published in the Journal of Rheumatology.

The researchers tried to evaluate the results of stroke in patients with and without SLE who were admitted to Tuen Mun Hospital in Hong Kong, China over a period of 20 years. They assessed the short-term functional stroke outcomes at 90 days, stroke patterns and 30-day stroke recurrence rates, mortality rates, and complications.

The primary study result was the 90-day functional recovery after a stroke as assessed using the modified Rankin scale (mRS); mRS values ​​from 0 to 2 represented the functional independence and values ​​from 3 to 6 represented the functional dependency. Secondary outcomes included 30-day and long-term mortality rates from all causes, stroke complications, stroke recurrence rates, and the need for neurosurgical intervention.

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Patients aged 18 and over who had been admitted to the hospital’s acute unit for a stroke between 1997 and 2017 were selected for the study. A total of 40 patients with SLE and 120 age- and sex-matched non-SLE control persons were examined. The baseline demographics were similar in the two groups. However, a higher percentage of patients with vs without SLE received antithrombotic therapy prior to stroke. The age of the patient at the onset of the stroke was 44.7 ± 13.7 years; A total of 87.5% of the participants were women.

The occurrence of ischemic stroke was significantly more common in patients with SLE than in non-SLE participants (90.0% versus 62.5%; P = 0.001). In addition, a significantly higher percentage of patients with vs. without SLE had a border zone infarction (27.8% vs. 12.0%; P <0.001) and multiple infarcts (33.3% vs. 4.0%; P <0.001). In ischemic stroke patients, a greater percentage of patients with SLE compared to non-SLE participants had extensive disease on imaging (69.4% versus 18.7%; P <0.001).

The National Institute of Health Stroke Scale (NIHSS) scores were significantly higher among participants with a more extensive infarction than those with no extensive infarction (median values ​​4.0 ± 6.6 versus 2.0 ± 1.6; P = 0.001 ). Overall, compared to non-SLE controls, patients with SLE were more functionally dependent 90 days after the stroke. According to the logistic regression analysis, SLE was significantly associated with a poor stroke function outcome, regardless of gender, age, previous stroke, severity of the stroke and atherosclerotic risk factors (odds ratio, 5.4; 95% CI, 1.1-26.0; P = .035).

After an observation period of 8.4 ± 6.1 years, all-cause mortality (37.5% versus 8.3%; P <0.001), stroke recurrence (30% versus 9.2%; P = 0.002) and post-stroke seizure (22 , 5% versus 3.3)%; P = 0.001) were all significantly more common in patients with SLE. The researchers found that SLE was independently associated with all-cause mortality and stroke recurrence.

A major limitation of the current study was the retrospective design, which was missing several confusing variables, including the antiphospholipid antibody status in the control group.

The researchers concluded, “Further prospective population-based studies are needed to investigate the mechanism of poorer functional outcomes in SLE stroke. This includes semiquantitative analysis of neuroradiological patterns as well as SLE-specific risk factors and biomarkers for vascular injury.”

reference

Tsoi LK, Mok CC, Mann BL, Fu YP. Imaging patterns and stroke outcome in patients with systemic lupus erythematosus: a case-control study. J Rheumatol. 2021; 48 (4): 533- 540. doi: 10.3899 / jrheum.200664

This article originally appeared on Rheumatology Advisor