Stroke subtypes among young patients with systemic lupus erythematosus

Systemic lupus erythematosus (lupus) is a systemic inflammatory disease associated with premature atherosclerosis, vasculitis, coagulopathy, and excessive incidence of stroke, especially among young patients. Little is known about subtypes of stroke in lupus.

A 20% sample of all the hospitalizations in the United States in the years 2001 and 2002 (N approximately 15 million) were analyzed to identify hospitalizations of young patients (age < or =50 years) with systemic lupus erythematosus (n=25704). Proportions of hospitalization for stroke subtypes were compared between the lupus group and the general population group. Age- and sex-adjusted odds ratios for stroke were calculated with logistic regression models.

In the lupus group, there were 313 hospitalizations for stroke of which 206 hospitalizations had stroke as the primary diagnosis. Age- and sex-adjusted stroke risk was higher among the lupus group (odds ratio 1.5, 95% confidence interval 1.3-1.8). Patients with lupus had higher risk for all stroke subtypes except in subarachnoid hemorrhage in which a trend toward a lower risk was observed (odds ratio 0.57, 95% confidence interval 0.34-0.96). Although 12.3% (n=38) of stroke admissions in the lupus group resulted in in-hospital death, this case fatality rate was not statistically different from that for stroke in the general population group.

Stroke is an important poor outcome in young patients with lupus. Compared with the general population, patients with lupus are more likely to be hospitalized for the risk of ischemic stroke and intracerebral hemorrhage. The risk of subarachnoid hemorrhage, however, seems to be lower in patients with lupus.