Mortality related to cerebrovascular disease in systemic lupus erythematosus

Abstract

The objective of this study was to examine mortality rates related to cerebrovascular disease in systemic lupus erythematosus (SLE) compared to the general population. Our sample was a multisite Canadian SLE cohort (10 centres, n = 2688 patients). Deaths due to cerebrovascular disease were ascertained by vital statistics registry linkage using ICD diagnostic codes. Standardized mortality ratio (SMR, ratio of deaths observed to expected) estimates were calculated. The total SMR for death due to cerebrovascular disease was 2.0 (95% confidence interval [CI] 1.0, 3.7). When considering specific types of events, the category with the greatest increased risk was that of ill-defined cerebrovascular events (SMR 44.9, 95% CI 9.3, 131.3) and other cerebrovascular disease (SMR 8.4, 95% CI 2.3, 21.6). Deaths due to cerebral infarctions appeared to be less common than hemorrhages and other types of cerebrovascular events. Our data suggest an increase in mortality related to cerebrovascular disease in SLE patients compared to the general population. The large increase in illdefined cerebrovascular events may represent cases of cerebral vasculitis or other rare forms of nervous system disease; alternately, it may reflect diagnostic uncertainty regarding the etiology of some clinical presentations in SLE patients. The suggestion that more deaths are attributed to cerebral hemorrhage, as opposed to infarction, indicates that inherent or iatrogenic factors (eg, thrombocytopenia or anticoagulation) may be important. In view of the paucity of large-scale studies of mortality attributed to neuropsychiatric outcomes in SLE, our findings highlight the need for additional research in large SLE cohorts.

Keywords

cerebrovascular disease mortality systemic lupus erythematosus

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References

Petri M. Epidemiology of systemic lupus erythematosus . Best Practice & Research Clinical Rheumatology 2002; 16: 847-858 .

Hanly JG. Neuropsychiatric lupus . Rheum Dis Clin North Am 2005; 31: 273-298 .

Hanly JG , Walsh NM , Sangalang V. Brain pathology in systemic lupus erythematosus . J Rheumatol 1992; 19: 732-741 .

Johnson RT , Richardson EP. The neurological manifestations of systemic lupus erythematosus . Medicine (Baltimore) 1968; 47: 337-369 .

Ellis SG , Verity MA. Central nervous system involvement in systemic lupus erythematosus: a review of neuropathologic findings in 57 cases, 1955-1977 . Semin Arthritis Rheum 1979; 8: 212-221 .

Mody G , Parag K , Nathoo B , Pudifin D , Duursma J , Seedat Y. High mortality with systemic lupus erythematosus in hospitalized African blacks . Br J Rheumatol 1994; 33: 1151-1153 .

Samanta A , Feehally J , Roy S , Nichol F , Sheldon P , Walls J. High prevalence of systemic disease and mortality in Asian subjects with systemic lupus erythematosus . Ann Rheum Dis 1991; 50: 490-492 .

Jonsson H , Nived O , Sturfelt G. Outcome in systemic lupuserythematosus-a prospective-study of patients from a defined population . Medicine 1989; 68: 141-150 .

Isenberg D , Gladman D. The Systemic Lupus International Collaborating Clinics group-origins and outcomes . Lupus 2001; 10: 375-377 .

10.

Bernatsky S , Boivin J-F , Joseph L et al. An international cohort study of cancer in SLE . Arthritis Rheum 2005; 52: 1481-1490 .

11.

Hochberg M. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum 1998; 41: 751-751 .

12.

Tan E , Cohen AS , Fries J , Masi A , McShane D , Rothfield N. The 1982 revised criteria for the classification of SLE . Arthritis Rheum 1982; 25: 1271-1277 .

13.

Breslow ND. Statistical methods in cancer research. The design and analysis of cohort studies. WHO International Agency for Research on Cancer , 1987: 302-304.

14.

Bjornadal L , Yin L , Granath F , Klareskog L , Ekbom A. Cardiovascular disease a hazard despite improved prognosis in patients with systemic lupus erythematosus: results from a Swedish population based study 1964-95 . J Rheumatol 2004; 31: 713-719 .

15.

Abu-Shakra M , Urowitz MB , Gladman DD , Gough J. Mortality studies in systemic lupus erythematosus. Results from a single center. II. Predictor variables for mortality . J Rheumatol 1995; 22: 1265-1270 .

16.

Abu-Shakra M , Urowitz MB , Gladman DD , Gough J. Mortality studies in systemic lupus erythematosus. Results from a single center. I. Causes of death . J Rheumatol 1995; 22: 1259-1264 .

17.

Rosner S , Ginzler EM , Diamond HS et al. A multicenter study of outcome in systemic lupus erythematosus . Arthritis Rheum 1982; 25: 612-617 .

18.

Stoll T , Seifert B , Isenberg D. SLICC/ACR Damage Index is valid, and renal and pulmonary organ scores are predictors of severe outcome in patients with systemic lupus erythematosus . Br J Rheumatol 1996; 35: 248-254 .

19.

Jonsen A , Bengtsson AA , Nived O , Ryberg B , Sturfelt G. Outcome of neuropsychiatric systemic lupus erythematosus within a defined Swedish population: increased morbidity but low mortality . Rheumatology 2002; 41: 1308-1312 .

20.

Ward M. Education level and mortality in systemic lupus erythematosus (SLE): evidence of underascertainment of deaths due to SLE in ethnic minorities with low education levels . Arthritis Rheum 2004; 51: 616-624 .