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, as well as higher mortality and recurrence rates, according to results of an analysis published in The Journal of Rheumatology.

Researchers sought to assess the outcomes of stroke in patients with SLE and those without SLE who were admitted to Tuen Mun Hospital in Hong Kong, China, during a 20-year period. They evaluated the short-term functional stroke outcomes at 90 days, stroke patterns, and 30-day stroke recurrence rates, mortality rates, and complications.

The primary study outcome was the 90-day functional recovery following stroke, as assessed by the modified Rankin scale (mRS); mRS scores of 0 to 2 represented functional independence and scores of 3 to 6 represented functional dependence. Secondary outcomes included all-cause 30-day and long-term mortality rates, complications of stroke, stroke recurrence rates, and need for neurosurgical intervention.

Patients who were 18 years and older and had been admitted to the acute medical ward at the hospital for 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 participants were evaluated. The baseline demographic data were similar among the 2 groups; however, a higher percentage of patients with vs without SLE received antithrombotic therapy prior to the stroke. Patient age at stroke occurrence was 44.7±13.7 years; overall, 87.5% of the participants were women.

The occurrence of ischemic stroke was significantly more common among patients with SLE compared with non-SLE participants (90.0% vs 62.5%, respectively; P =.001). Further, a significantly higher percentage of patients with vs without SLE had border zone infarct (27.8% vs 12.0%, respectively; P <.001) and multiple infarcts (33.3% vs 4.0%, respectively; P <.001). Among patients who had an ischemic stroke, a greater percentage of patients with SLE had extensive disease on imaging compared with non-SLE participants (69.4% vs 18.7%, respectively; P <.001).

Among participants with more extensive infarct, National Institute of Health Stroke Scale (NIHSS) scores were significantly higher than in those without extensive infarct (median scores, 4.0±6.6 vs 2.0±1.6, respectively; P =.001). Overall, patients with SLE vs the non-SLE control participants were more functionally dependent at 90 days poststroke. According to the logistic regression analysis, SLE was significantly associated with a poor stroke functional outcome independent of sex, age, prior stroke, severity of stroke, and atherosclerotic risk factors (odds ratio, 5.4; 95% CI, 1.1-26.0; P =.035).

Following an observation period of 8.4±6.1 years, all-cause mortality (37.5% vs 8.3%; P <.001), stroke recurrence (30% vs 9.2%; P =.002), and poststroke seizure (22.5% vs 3.3%; P= .001) all occurred significantly more often in patients with SLE. Researchers noted that SLE was independently associated with all-cause mortality and stroke recurrence.

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

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

Reference

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