Mortality and Functionality after Stroke in Patients with Systemic Lupus Erythematosus

Area of Science:

• Neurology
• Rheumatology
• Public Health

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with known cardiovascular risks.
• Stroke is a significant complication, but its impact on mortality and functional outcomes in SLE patients requires further investigation.

Purpose of the Study:

• To compare mortality and functional impairment after first-ever ischemic or hemorrhagic stroke in individuals with and without SLE.
• To identify specific risks associated with stroke in the SLE population.

Main Methods:

• Utilized Swedish nationwide registers to identify 423 SLE patients and 1652 non-SLE controls experiencing a first stroke (1998-2013).
• Estimated hazard ratios (HR) for all-cause death and risk ratios (RR) for functional impairment at 3 months post-stroke.
• Followed patients until death or for 1 year post-stroke.

Main Results:

• One-year mortality after stroke was higher in SLE patients (22%) compared to controls (16%).
• SLE patients had increased mortality risk post-ischemic stroke (HR 1.85), attenuated after comorbidity adjustment (HR 1.41).
• Functional impairment at 3 months post-ischemic stroke was nearly doubled in SLE patients (RR 1.73).
• SLE patients showed a significantly higher mortality risk post-hemorrhagic stroke (HR 2.30), evident even within the first month.

Conclusions:

• Systemic lupus erythematosus (SLE) is associated with increased mortality and functional impairment following stroke.
• Mortality risk increases after the first month for ischemic stroke and is elevated from the first month for hemorrhagic stroke in SLE patients.
• Clinical focus should shift towards improving patient functionality and prioritizing the prevention of hemorrhagic strokes in SLE management.