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Risk for subarachnoid hemorrhage greater among lupus patients
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Patients with systemic lupus erythematosus had a higher occurrence of spontaneous subarachnoid hemorrhage compared with people without the disorder, according to study results.
Researchers used the Taiwan National Health Insurance (NHI) database to identify 16,967 patients with systemic lupus erythematosus (SLE; mean age, 35.5 years; 89.5% women) and 16,967 randomly matched patients without SLE. Mean follow-up was 5.2 years for SLE patients and 5.37 years for the matched cohort. Risk factors for spontaneous subarachnoid hemorrhage (SAH) among SLE patients were evaluated using a Cox multivariate proportional hazard model. Researchers also examined NHI data from the general population and determined that 642 of 1 million patients developed SAH during the 7-year study.
Patients with SLE experienced more events (45 vs. 9 events; P<.001) and a higher incidence rate (49.4 vs. 10.2 per 100,000 people per year) of SAH compared with controls, and an incidence rate ratio of 4.84 (P<.001). SLE patients developed SAH at a younger age than matched cohorts (44.5 years vs. 57.7 years; P=.015). In addition, the mortality rate after SAH for the SLE group was greater (60% vs. 38.9%; P=.007) than that of the non-SLE general population.
Using Cox multivariate proportional hazards, independent risk factors for SAH onset among SLE patients were age (HR=1.03; 95% CI, 1.01-1.05), platelet transfusion (HR=2.75; 95% CI, 1.46-5.17), red blood cell transfusion (HR=7.11, 95% CI, 2.81-17.97) and average daily prednisolone dose greater than 10 mg (HR=4.36; 95% CI, 2.19-8.68).
“This study demonstrated that SAH is a rare but associated complication of SLE with a high mortality rate,” the researchers concluded. “Other than age, the risk factors of SAH might be associated with a higher level of lupus activity or hematologic involvement.”
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