Imaging pattern and outcome of stroke in patients with systemic lupus erythematosus: a case-control study.

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To evaluate the outcome of stroke in patients with systemic lupus erythematosus (SLE).Patients who fulfilled ≥4 ACR criteria for SLE and had a history of stroke from 1997-2017 were identified. The functional outcome of stroke (assessed by the modified Rankin Scale) at 90 days, mortality, stroke complications and recurrence were retrospectively studied and compared with matched non-SLE patients with stroke.40 SLE patients and 120 non-SLE patients with stroke (age at stroke 44.6±13.8 years; 88% women) were studied. Ischemic type of stroke (90% versus 63%; p=0.001) and extensive infarction (69% versus 28%; p<0.001) was more common in SLE than non-SLE patients. Border zone infarct and multiple infarcts on imaging were significantly more prevalent in SLE patients. Patients with SLE were more functionally dependent than controls at 90 days post-stroke. Logistic regression showed that SLE was significantly associated with a poor stroke functional outcome independent of age, sex, past stroke, atherosclerotic risk factors and the severity of stroke (OR 5.4[1.1-26.0]; p=0.035). Stroke mortality at 30 days was non-significantly higher in SLE than non-SLE patients but all-cause mortality (37.5% compared to 8.3%; p<0.001), recurrence of stroke (30% compared to 9.2%; p=0.002) and post-stroke seizure (22.5% compared to 3.3%; p=0.001) were significantly more common in SLE patients after an observation of 8.4±6.1 years. SLE was independently associated with all-cause mortality and stroke recurrence over time.Stroke in SLE patients is associated with a poorer outcome than matched controls in terms of functional recovery, recurrence and mortality.

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