THU0338 Outcome of stroke in patients with systemic lupus erythematosus: a nested case-control study
Authors: L.K. Tsoi, C.C. Mok, Y.P. Fu
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> To evaluate the outcome of stroke in patients with systemic lupus erythematosus (SLE) in comparison with matched non-SLE patients. <h3>Methods</h3> Patients who fulfilled ≥4 ACR criteria for SLE and had a history of stroke were identified from our SLE database. The outcome of stroke in these patients was evaluated retrospectively and compared with a group of randomly selected age/gender-matched non-SLE patients (in a 1:3 ratio) admitted to our stroke unit within the same time period. The type and extent of stroke, atherosclerotic risk factors (hypertension, smoking, diabetes mellitus, dyslipidemia, atrial fibrillation, valvular lesions) and previous 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 was studied by logistic regression. <h3>Results</h3> A total of 40 SLE patients (age 53.7±11.5, 88% women) with stroke were identified from our database (stroke prevalence 0.39/100 patient-year). A control group of 120 non-SLE patients (age 52.8±14.8, 87.5% women) with stroke were randomly selected from our stroke database. 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] (1.51±0.47 vs 1.32±0.31; p=0.005.) In SLE patients, the median time to stroke since diagnosis was 24 months. Ischaemic stroke was more common in SLE than non-SLE patients (90% vs 63%; p=0.001). Among patients with ischaemic stroke, SLE patients had more extensive infarction than controls on CAT scan (multiple infarct 65.7% vs 18.7%; p&lt;0.001). The 90 day mRS score was significantly higher in SLE patients than controls (1.70±1.97 vs 0.88±1.36; p=0.004). Significantly more SLE patients had functional dependence (mRS score 3–6) at 90 days post-stroke than controls (32.5 vs 8.3%; p&lt;0.001). 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 (ischaemic vs haemorrhagic) (OR 12.2 [2.97–49.9]). Subgroup analysis of patients with ischaemic stroke showed that SLE was also independently associated with a poorer functional outcome after adjustment for the same confounding covariates and the extent of stroke (solitary vs multiple infarcts) (OR 12.4 [1.02–150]; p=0.048). There was no significant difference in the 30 day stroke mortality between SLE and non-SLE patients (5% vs 2.5%; p=0.43). However, SLE patients had a higher incidence of post-stroke epilepsy than controls (22.5% vs 3.3%; p=0.001). Upon a mean follow-up time of 7.5±5.2 years, SLE patients had a lower stroke recurrence free survival (59.5% vs 85.7%; p&lt;0.001) and a higher rate of all-cause mortality (34.6% vs 15.1%;p&lt;0.001). <h3>Conclusions</h3> Stroke in SLE patients is more likely to be ischaemic 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. <h3>Disclosure of Interest</h3> None declared