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Abstract Number: 2990

Risk Factors for Posterior Reversible Encephalopathy Syndrome in Systemic Lupus Erythematosus Patients: A Single Center Study

Javier Merayo-Chalico1, Elia Apodaca2, Ana Barrera-Vargas3, Jorge Alcocer-Varela3 and Diana Gómez-Martín3, 1Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 2Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico, 3Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Lupus nephritis, lymphopenia, posterior reversible encephalopathy syndrome and systemic lupus erythematosus (SLE)

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Session Information

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment: Central Nervous System and Other Clinical Aspects

Session Type: Abstract Submissions (ACR)

Background/Purpose:  Posterior reversible encephalopathy syndrome (PRES) is a well-known but rare complication in systemic lupus erythematosus (SLE) patients (<1%). However, current epidemiologic data is quite scant. The aim of the present study was to describe potentially unrecognized risk factors.

Methods: We performed a single-center retrospective case-control study in a tertiary care center in Mexico City between 1999 and 2014. We included 48 patients (cases) with SLE diagnosis (≥4 ACR criteria) who presented with reversible neurological manifestations (seizures, visual abnormalities, acute confusional state, among others) associated with changes by magnetic resonance (MRI) (iso or hypointensity in T1 and hyperintensity in T2/FLAIR). Controls (n=96) were patients with SLE without evidence of PRES that were hospitalized during the same period as cases (± 3 months) and matched by gender. Association between variables was calculated by X2 test and OR (95% CI). Multivariate analysis was performed by logistic regression.

Results: SLE patients with PRES were younger (27.9±1.05 vs 36.2±1.36 years, p˂0.001). Ninety percent of the cases occurred in women. PRES occurred in 28/48 patients (40%) after 24 hours of admission (2-30 days). The vast majority (80.2%) of cases presented with seizures, and up to 18% showed “atypical” MRI images. Decrease or resolution of MRI images in the first 12 weeks after the event occurred in 88.8% of cases.  Variables associated with the development of PRES, three months prior to hospitalization and at the time of the event are summarized in Table 1. After multivariate analysis, hypertension at admission [OR 16.3, 95% CI 4.03-65.85, p˂0.001], renal replacement therapy at discharge [OR 6.65, 95% CI 1.24-35.64, p=0.027], persistent lymphopenia (˂1,000 cells/uL in at least two consecutive measurement previous to the event) [OR 5.76, 95% CI 1.36-24.40, p=0.017], SLEDAI≥6 prior to admission [OR 1.11, 95% CI 1.01-1.22, p=0.031] and age [OR 0.863, 95% CI 0.81-0.91, p˂0.001] were independent risk factors for the development of PRES in SLE. Length of hospital stay was similar between groups (17.2±2.07 vs 14.60±1.11 days, p=0.26) and none of the cases died during hospitalization.

Conclusion: Our data is in agreement with prior studies that link end-stage renal disease, hypertension and high SLEDAI scores to the development of PRES in SLE. Furthermore, we found that persistent lymphopenia is a novel independent risk factor for PRES in SLE, which could be related to endothelial dysfunction in these patients.

Table 1.Variables associated with development of PRES in SLE patients (univariate analysis)

Three months prior to admission

OR

95% CI

p value

SLEDAI ≥6 points

4.41

1.87-10.40

<0.001

Hypertension

3.50

1.68-7.32

0.001

Lymphopenia

3.36

1.36-8.29

0.006

Low C3 levels

2.71

1.21-6.07

0.013

History of renal replacement therapy

2.66

1.15-6.12

0.019

 

At admission

 

OR

 

95% CI

 

p value

SLEDAI ≥6 points

33.80

4.43-257.54

<0.001

Hypertension

13.63

5.88-31.56

<0.001

GFR ≤60 mL/min/1.73 m2

4.75

1.93-11.65

<0.001

Renal replacement therapy at discharge

4.27

1.97-9.24

<0.001

Low C3 levels

2.22

1.02-4.81

0.041


Disclosure:

J. Merayo-Chalico,
None;

E. Apodaca,
None;

A. Barrera-Vargas,
None;

J. Alcocer-Varela,
None;

D. Gómez-Martín,
None.

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