Marios Rossides1,2, Julia F Simard3,4, Elisabet Svenungsson3,4, Mia von Euler3,4, Elizabeth V Arkema3,4. 1. From the Clinical Epidemiology Unit, Department of Medicine Solna, and the Unit of Rheumatology, Solna, and Stroke Research Network, Södersjukhuset, and Department of Clinical Science and Education, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Division of Epidemiology, Department of Health Research and Policy, and Division of Immunology and Rheumatology, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California, USA. marios.rossides@ki.se. 2. M. Rossides, MD, MSc, Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet; J.F. Simard, ScD, Division of Epidemiology, Department of Health Research and Policy, and Division of Immunology and Rheumatology, Department of Medicine, Stanford School of Medicine, Stanford University, and Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet; E. Svenungsson, MD, PhD, Unit of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital; M. von Euler MD, PhD, Stroke Research Network, and Department of Clinical Science and Education, Karolinska Institutet; E.V. Arkema, ScD, Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet. marios.rossides@ki.se. 3. From the Clinical Epidemiology Unit, Department of Medicine Solna, and the Unit of Rheumatology, Solna, and Stroke Research Network, Södersjukhuset, and Department of Clinical Science and Education, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Division of Epidemiology, Department of Health Research and Policy, and Division of Immunology and Rheumatology, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California, USA. 4. M. Rossides, MD, MSc, Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet; J.F. Simard, ScD, Division of Epidemiology, Department of Health Research and Policy, and Division of Immunology and Rheumatology, Department of Medicine, Stanford School of Medicine, Stanford University, and Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet; E. Svenungsson, MD, PhD, Unit of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital; M. von Euler MD, PhD, Stroke Research Network, and Department of Clinical Science and Education, Karolinska Institutet; E.V. Arkema, ScD, Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet.
Abstract
OBJECTIVE: To investigate mortality and functional impairment after stroke in systemic lupus erythematosus (SLE). METHODS: Using Swedish nationwide registers, we identified 423 individuals with SLE and 1652 people without SLE who developed a first-ever ischemic or hemorrhagic stroke (1998-2013) and followed them until all-cause death or for 1 year. HR for death after ischemic or hemorrhagic stroke and the risk ratio of functional impairment (dependence in either transferring, toileting, or dressing) 3 months after ischemic stroke were estimated. RESULTS: One year after stroke, 22% of patients with SLE versus 16% of those without SLE died. After ischemic stroke, patients with SLE had an increased risk of death (HR 1.85, 95% CI 1.39-2.45), which was attenuated after controlling for SLE-related comorbidities (HR 1.41, 95% CI 1.04-1.91). Functional impairment at 3 months was increased in SLE by almost 2-fold (risk ratio 1.73, 95% CI 1.16-2.57). After hemorrhagic stroke, patients with SLE had an HR of 2.30 (95% CI 1.38-3.82) for death, which was increased even during the first month. CONCLUSION: Compared to subjects without SLE, mortality after ischemic stroke increases after the first month in individuals with SLE, and functionality is worse at 3 months. SLE is associated with all-cause death after hemorrhagic stroke even during the first month. A shift of focus to patient functionality and prevention of hemorrhagic strokes is required.
OBJECTIVE: To investigate mortality and functional impairment after stroke in systemic lupus erythematosus (SLE). METHODS: Using Swedish nationwide registers, we identified 423 individuals with SLE and 1652 people without SLE who developed a first-ever ischemic or hemorrhagic stroke (1998-2013) and followed them until all-cause death or for 1 year. HR for death after ischemic or hemorrhagic stroke and the risk ratio of functional impairment (dependence in either transferring, toileting, or dressing) 3 months after ischemic stroke were estimated. RESULTS: One year after stroke, 22% of patients with SLE versus 16% of those without SLE died. After ischemic stroke, patients with SLE had an increased risk of death (HR 1.85, 95% CI 1.39-2.45), which was attenuated after controlling for SLE-related comorbidities (HR 1.41, 95% CI 1.04-1.91). Functional impairment at 3 months was increased in SLE by almost 2-fold (risk ratio 1.73, 95% CI 1.16-2.57). After hemorrhagic stroke, patients with SLE had an HR of 2.30 (95% CI 1.38-3.82) for death, which was increased even during the first month. CONCLUSION: Compared to subjects without SLE, mortality after ischemic stroke increases after the first month in individuals with SLE, and functionality is worse at 3 months. SLE is associated with all-cause death after hemorrhagic stroke even during the first month. A shift of focus to patient functionality and prevention of hemorrhagic strokes is required.
Authors: Helena Enocsson; Jesper Karlsson; Hai-Yun Li; Yi Wu; Irving Kushner; Jonas Wetterö; Christopher Sjöwall Journal: J Clin Med Date: 2021-12-13 Impact factor: 4.241