Background/Purpose: To evaluate the outcome of stroke in patients with systemic lupus erythematosus (SLE) in comparison with non-SLE patients.

Methods: Patients who fulfilled ≥4 SLICC/ACR criteria for SLE and had a history of cerebrovascular accident (stroke) were retrieved from our SLE database. The outcome of stroke in these patients was evaluated retrospectively and compared with a group of randomly selected age and gender matched non-SLE patients (in a 1:3 ratio) admitted to our stroke unit within the same time period. The type and pattern of stroke, atherosclerotic risk factors and previous history of stroke were compared between the two groups of patients. The primary outcome of interest was the 90-day functional outcome as assessed by the modified Rankin scale (mRS) (score 0-2 = functional independence; score 3-6 = functional dependence). Secondary outcomes included all-cause mortality, 30-day stroke mortality, stroke recurrence and stroke complications. Factors independently associated with a poor functional outcome (mRS 3-6) was studied by logistic regression.

Results:

40 SLE patients (age 53.7±11.5, 87.5% women) with stroke were identified (stroke prevalence 0.39/100 patient-year) and 120 non-SLE control patients (age 52.8±14.8, 87.5% women) with stroke were randomly selected. All were ethnic Chinese. The prevalence of atherosclerotic risk factors was similar between the two groups, except SLE patients had a higher atherogenic index (Log serum [triglyceride/HDL-cholesterol]. Ischemic stroke was more common in SLE than non-SLE patients (90% vs 63%; p=0.001). Among patients with ischemic stroke, SLE patients had more extensive infarction (defined as diffuse white matter lesions, multiple infarcts involving >1 major vascular territory or one single major vessel >50% involvement) than controls on CAT scan (69.4% vs 28%; p<0.001). Significantly more SLE patients had functional dependence (mRS score 3-6) at 90 days post-stroke than controls (32.5 vs 8.3 %; p<0.001; unadjusted OR14.2). Logistic regression showed that SLE was an independent risk factor for a poor stroke outcome after adjustment for age, sex, history of stroke, various atherosclerotic risk factors and the type of stroke (ischemic vs hemorrhagic) (OR 10.1 [2.7–38.0]; p=0.001). In a subgroup of patients with ischemic stroke, SLE remained an independent factor for a poorer functional outcome after adjustment for the same covariates and the extent of stroke (OR 14.0 [2.0–96.2]; p=0.007). Although there was no significant difference in the 30-day stroke mortality between SLE and non-SLE patients (5% vs 2.5%; p=0.43), SLE patients had a higher incidence of post-stroke epilepsy (22.5% vs 3.3%; p=0.001). Upon a follow-up of 7.5±5.2 years, SLE patients had a lower stroke recurrence free survival (59.5% vs 85.7%; p<0.001) and a higher rate of all-cause mortality (34.6% vs 15.1%; p<0.001).

Conclusion: Stroke in SLE patients is more likely to be ischemic in origin and more extensive than matched controls. Short-term functional outcome of stroke is poorer in SLE patients. Over 7.5 years, stroke recurrence, post-stroke epilepsy and all-cause mortality is significantly more frequent in SLE than non-SLE patients.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcome-of-stroke-in-patients-with-systemic-lupus-erythematosus-a-nested-case-control-study/