Background Stroke is a severely disabling complication that occurs at a much earlier age in patients with systemic lupus erythematosus (SLE) compared to the general population.1 Individuals with SLE have also a greater risk of stroke compared to the general population. However, it remains unclear if stroke patients with SLE have higher mortality after stroke.
Objectives To assess the mortality after first-ever stroke in SLE patients compared to the general population.
Methods In a prospective cohort of adult SLE patients (≥2 SLE visits, ≥1 with a specialist in the National Patient Register, NPR) and general population comparators identified from the Total Population Register, we identified those with first-ever stroke via the NPR (ischaemic, intracerebral haemorrhage, and unspecified), from 1998 to 2013. We linked them to the Swedish Stroke Register (Riksstroke) and followed them from occurrence of stroke until end of follow-up (death or the end of the study (Nov 2014)). We used age-adjusted Cox models to estimate the hazard ratio (HR) for all-cause mortality and stroke-specific mortality (defined using ICD codes from the Cause of Death Register) for SLE compared to non-SLE. For all-cause mortality, we estimated HRs for death within the first 30, 90, or 180 days after stroke. We additionally adjusted for comorbidities (hypertension, diabetes, congestive heart disease, atrial fibrillation and renal disease). In patients with Riksstroke records we further adjusted for smoking, aspirin and statin use at baseline (and thrombolysis for ischaemic stroke).
Results We identified 467 individuals with SLE and 1775 non-SLE comparators with a first-ever stroke. SLE patients were younger than non-SLE at inclusion (mean age 66 yrs vs. 77 yrs). During follow-up, we identified 1293 deaths in both groups. After adjusting for age, stroke patients with SLE had a 50% higher rate of all-cause death for all stroke types compared to non-SLE, with the highest observed for intracerebral haemorrhage (HR=2.0; 95% CI=1.3–3.1). The HRs were similar after adjusting for comorbidities. Restricting to patients registered in Riksstroke, the HRs for mortality were similar, except for unspecified stroke. The hazard of death within the first 30 days was higher in the SLE group only for intracerebral haemorrhage (HR 1.99). Within 90 and 180 days, SLE patients are at higher risk of death compared to non-SLE for all stroke types. The stroke-specific mortality HR was 1.3 (95% CI=1.0–1.7) for all stroke types.
Conclusions The rate of any cause and stroke-specific death after stroke is greater in patients with SLE than the general population, despite controlling for factors affecting mortality.
Behrouz R. J Neuroimmunol. 2014;277(1–2):1–5.
Disclosure of Interest M. Rossides: None declared, J. Simard: None declared, E. Svenungsson: None declared, M. von Euler Grant/research support from: Folksam and Bliwa, E. Arkema: None declared
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