Session Information
Title: Epidemiology and Public Health (ACR): Rheumatoid Arthritis and Systemic Lupus Erythematosus Outcomes
Session Type: Abstract Submissions (ACR)
Background/Purpose
Central nervous system involvement is common in Systemic Lupus Erythematosus (SLE) and was first described in 1873. Though ischemic involvement is more common than Intra-Cerebral Hemorrhage (ICH) in SLE, hemorrhagic involvement is more life threatening and disabling. Several studies have shown that SLE patients with ICH present with higher frequency of Anti-Phospho-Lipid-Antibody (aPL) syndrome. In our study we tried to investigate if SLE or aPL syndrome independently predicts risk of ICH in CVA.
Methods
We queried the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample (NIS) between 2004 and 2010 and separated the hospitalizations due to or with stroke using ICD 9 diagnostic codes previously established by HCUP. Among this population, we examined the patients with SLE and patients with aPL syndrome and compared their risk of ICH to the all stroke population using the logistic regression model. The model was controlled for confounders which included age, sex, atrial fibrillation, chronic kidney disease, diabetes mellitus, rheumatoid arthritis, chronic rheumatic heart disease and diseases of endocardium. Using SAS 9.2, survey procedures were used to identify multivariate predictors of stroke.
Results
A total of 1,799,560 (weighted N= 8,874,475) who were hospitalized with stroke were available for analysis out of which 6,890 (weighted N= 33,882) had SLE and 13,769 (weighted N=68,069) had aPL syndrome. On univariate analysis, among patients with SLE 1.41% developed ICH as compared to 1.29% in patients without SLE (p = 0.06); and among patients with aPL syndrome 3.5% developed ICH as compared to 1.28% in patients without aPL syndrome (p<0.001). After controlling for confounders mentioned above, co-morbid SLE was associated with decreased risk of having ICH (Odds Ratio (OR)= 0.68, Confidence Interval (CI)=0.53-0.89, p < 0.0039) in patients with stroke. Whereas, co-morbid aPL was associated with increased risk of having ICH (OR= 1.93, CI=1.72-2.17, p<0.0001), in patients with stroke.
Table 1: Multivariable predictors of ICH in the study population for stroke (N= 1,799,560)
|
Variables |
Model |
|
|
|
OR with 95% CI |
P value |
|
Age |
0.984 (0.982-0.985) |
<0.0001 |
|
Female Gender |
1.039 (1.001-1.079) |
0.0434 |
|
Race(African American vs Caucasian) |
1.154 (1.083-1.229) |
<0.0001 |
|
CCI |
1.097 (1.081-1.113) |
<0.0001 |
|
Systemic Lupus Erythematosus |
0.683 (0.528-0.885) |
0.0039 |
|
Antiphosholipidantibody syndrome |
1.932 (1.716-2.176) |
<0.0001 |
|
Chronic Kidney Disease |
0.909 (0.864-0.955) |
0.0002 |
|
Atrial fibrillation |
1.583 (1.512-1.658) |
<0.0001 |
|
Diseases of endocardium |
0.706 (0.658-0.757) |
<0.0001 |
|
Rheumatic heart disease |
0.857 (0.774-0.948) |
0.0028 |
|
Rheumatoid Arthritis |
0.778 (0.679-0.891) |
0.0003 |
|
Scleroderma |
0.744 (0.428-1.294) |
0.2951 |
|
Diabetes Mellitus |
0.631 (0.606-0.656) |
<0.0001 |
|
Teaching Hospital Status |
2.252 (2.024-2.507) |
<0.0001 |
*CCI = Charlson Co-morbidity Index.
Conclusion
In addition to the understanding of increased risk of CVA in SLE and aPL Syndrome patients, further understanding of the nature of the cerebrovascular disease can influence treatment strategies. Our study showed that SLE patients are at decreased risk of hemorrhagic stroke in comparison to general stroke population. However, aPL Syndrome patients are at increased risk of hemorrhagic stroke in comparison to general stroke population. This suggests that aPL component of the disease spectrum predisposes the patients to ICH.
Disclosure:
T. Mehta,
None;
K. Sheth,
None;
R. Soni,
None;
S. Puri,
None;
K. Mehta,
None.
ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-intra-cranial-hemorrhage-among-patients-with-anti-phospho-lipid-antibody-apl-syndrome-vs-systemic-lupus-erythematosus-sle-in-stroke-population-a-nationwide-analysis/