Imaging Pattern and Outcome of Stroke in Patients With Systemic Lupus Erythematosus: A Case-control Study

Objective: To evaluate the outcome of stroke in patients with systemic lupus erythematosus (SLE).

Methods: Patients who fulfilled ≥ 4 American College of Rheumatology criteria for SLE and had a history of stroke from 1997 to 2017 were identified. The functional outcome of stroke [assessed by the modified Rankin Scale (mRS) at 90 days], mortality, stroke complications, and recurrence were retrospectively studied and compared with matched non-SLE patients with stroke.

Results: Forty SLE patients and 120 non-SLE patients with stroke (age at stroke 44.7 ± 13.7 yrs, 87.5% women) were studied. Ischemic type of stroke (90% vs 63%, P = 0.001) and extensive infarction (69.4% vs 18.7%, P < 0.001) were more common in SLE than non-SLE patients. Border zone infarct and multiple infarcts on imaging were significantly more prevalent in SLE patients. Patients with SLE were more functionally dependent than controls at 90 days poststroke. Logistic regression showed that SLE was significantly associated with a poor stroke functional outcome independent of age, sex, past stroke, atherosclerotic risk factors, and the severity of stroke (OR 5.4, 95% CI 1.1-26.0, P = 0.035). Stroke mortality at 30 days was nonsignificantly higher in SLE than non-SLE patients, but all-cause mortality (37.5% compared to 8.3%, P < 0.001), recurrence of stroke (30% compared to 9.2%, P = 0.002), and poststroke seizure (22.5% compared to 3.3%, P = 0.001) were significantly more common in SLE patients after an observation of 8.4 ± 6.1 years. SLE was independently associated with all-cause mortality and stroke recurrence over time.

Conclusions: Stroke in patients with SLE is associated with a poorer outcome than matched controls in terms of functional recovery, recurrence, and mortality.