Increased Risk of Subarachnoid Hemorrhage in Patients With Systemic Lupus Erythematosus: A Nationwide Population‐Based Study

Abstract

Objective. A relatively common occurrence of spontaneous subarachnoid hemorrhage (SAH) in patients with systemic lupus erythematosus (SLE) has been noted; however, the subsequent studies were conflicting. This nationwide populationbased study aimed to evaluate the risk of SAH in patients with SLE. Methods. We identified 16,967 SLE patients from the Taiwan National Health Insurance (NHI) database between 2000 and 2006, and compared the incidence rate of SAH with 16,967 randomly selected age-and sex-matched non-SLE subjects. A Cox multivariable proportional hazards model was used to evaluate the risk factors of SAH in the SLE cohort. Results. The SLE cohort had a higher risk of SAH, with an incidence rate ratio of 4.84 (P < 0.001). Despite a younger age, the mortality rate after SAH was significantly higher in the SLE cohort compared to all of the non-SLE SAH patients identified from the 1 million NHI beneficiaries (60.0% versus 38.9%; P ‫؍‬ 0. Conclusion. This study demonstrated that SAH is a rare but associated complication of SLE with a high mortality rate. Other than age, higher mean daily steroid use and a history of platelet or red blood cell transfusion were associated with the occurrence of SAH in patients with SLE.

Stroke in systemic lupus erythematosus: a meta-analysis of population-based cohort studies

“… 18 Three examined subarachnoid haemorrhage separately. 14 19 20 Six studies presented estimates for ischaemic stroke, 13 15 17 18 20 21 one of which included the ICD-9 code for subarachnoid haemorrhage (ICD-9 430) in the ischaemic stroke outcome. 17 Liou et al investigated the risk of intracerebral haemorrhage; they did not give the number of events or subtype-specific HR, and only reported that the finding was non-significant.…”

Subarachnoid hemorrhage in systemic lupus erythematosus: Systematic review and report of three cases

“…It is well known that these drugs can cause hypertension as a side effect [7,8,21], which could result in aneurysm formation and rupture, and therefore, could be one of the explanations for the higher rate of SAH in SLE patients. This hypothesis is also supported by the fact that higher daily steroid use (>10 mg) has been reported as an independent risk factor for increased incidence of SAH [4,9].…”

“…It seems that in some populations, older age, high dose (>10 mg daily) steroid intake, and previous transfusions of red blood cells or platelets are independent risk factors for SAH [4,34].…”

“…The central nervous system (CNS) can be affected in 25-50% of SLE patients mostly due to seizures, psychosis, and cerebrovascular accidents [3]. Incidence of subarachnoid hemorrhage (SAH) is considered higher in SLE patients than in the general population, with a rate of 49.4 vs. 10.2 per 100,000 person-years [4]. However, the underlying cerebral vasculitis described in SLE does not justify the pathophysiology of all the SAH cases, and the causes leading to this increased incidence remain unclear [5,6].…”

Non‐aneurysmal subarachnoid hemorrhage in two patients with systemic lupus erythematosus: Case reports and literature review

“…Subarachnoid hemorrhage (SAH) is rare in patients with systemic lupus erythematosus (SLE), but more common than in the general non‐SLE population . Although the pathogenesis of SAH in patients with SLE remains poorly understood, aneurysm is known to be the most common cause.…”