Connective Tissue Disease

Similar Outcomes for Ischemic Stroke Hospitalizations With and Without Systemic Sclerosis

Alyssa Capel
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Ischemic stroke is the most common severe neurologic complication of APS. Among 1000 people with APS participating in the Euro-Phospholipid Project, 20% presented with stroke and 11% presented with transient ischemic stroke.2,5 About 13% of patients with stroke are aPL-positive,2 and they are more likely to be younger or female compared with aPL-negative patients.3 More than 20% of strokes in patients <45 years may be related to APS.3 In APS, stroke occurs when a clot forms in an arterial vessel of the brain or when clot or plaque debris travels from another site (usually the heart) to a blood vessel in the brain.2,3 Less common cerebrovascular diseases seen in patients with APS that may increase stroke risk are cerebral venous thrombosis, reversible cerebral vasoconstriction syndrome, acute ischemic encephalopathy (a rare feature of SLE), and Sneddon syndrome.3 To reduce stroke risk, clinicians may want to discuss modifiable risk factors for vascular disease, such as smoking and obesity, with those who are positive for aPL.3 Image Credit: Zephyr/Science Source
Researchers compared the hospitalization outcomes of patients with ischemic stroke with and without a secondary diagnosis of systemic sclerosis.

Hospitalizations for ischemic stroke in patients with systemic sclerosis (SSc) had similar outcomes compared with those without SSc, according to study results published in Cureus.

Systemic sclerosis has been known to increase risk for cerebrovascular events, including ischemic stroke, but less is known about whether SSc negatively affects the outcomes of ischemic stroke hospitalizations.

Researchers extracted data from the National Inpatient Sample (NIS) database, the largest hospitalization database in the United States, for 2016 and 2017 to compare the outcomes of patients with SSc admitted for ischemic stroke with those without an SSc diagnosis. International Classification of Disease, Tenth Revision (ICD-10) codes were used to identify principal diagnoses of ischemic stroke and any secondary diagnosis. The primary outcome of the study was inpatient mortality; secondary outcomes were length of hospital stay, mean total hospital charges, odds of receiving tissue plasminogen activator, and mechanical thrombectomy.

Of the 525,570 adult hospitalizations for ischemic stroke included in the 2017 and 2017 NIS database, 410 patients had SSc (0.08%). Patient characteristics revealed that the SSc group had younger patients (65.5 vs 70.3 years, P =.004) and more patients who were women (84.2% vs 49.8%, P <.0001). Other characteristics included greater incidence of old stroke (18.3% vs 8.6%, P =.0015) and lesser diabetes mellitus (18.3% vs 36.5%, P =.0007).

Of the total ischemic stroke hospitalizations, 29,025 (5.5%) met the primary outcome of inpatient mortality, 25 of whom were patients with SSc. The SSc and non-SSc rates for inpatient mortality (6.1% and 5.5%, respectively; P =.492), length of stay (5.9 and 5.7 days, respectively; P =.583) and total hospital charge ($74,958 and $70,197, respectively; P =.700) were similar between the 2 groups. Odds of receiving tissue plasminogen activator and mechanical thrombectomy were also found to be similar between those with and without SSc (9.76% and 9.29%, respectively; P =.848 and 7.32% and 5.06%, respectively; P =.556, respectively).

These results showed that across both primary and secondary outcomes, SSc did not affect outcomes or the management of ischemic stroke; however, the researchers noted that the predominant underlying mechanisms by which SSc can increase risk for stroke are still unknown.

Based on these findings, the researchers concluded that despite SSc being a known risk factor of developing cerebrovascular events, SSc diagnosis did not negatively affect hospitalization outcomes for those admitted with ischemic stroke.

Limitations of the study included the possibility of errors in coding of the NIS database items, the fact that individual patients admitted multiple times would have been counted multiple times in the study, and that the cause of inpatient mortality was not available as part of the collected data.

Reference

Edigin E, Eseaton P, Kaul S, et al. Systemic sclerosis is not associated with worse outcomes of patients admitted for ischemic stroke: analysis of the National Inpatient Sample. Published online July 12, 2020. Cureus. doi:10.7759/cureus.9155

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