Clinical features and outcomes of posterior reversible encephalopathy syndrome in patients with systemic lupus erythematosus

Chien Chih Lai, Wei Sheng Chen, Yu Sheng Chang, Shu Hung Wang, Chun Jui Huang, Wan Yuo Guo, Wu Chang Yang, De Feng Huang

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objective To analyze the clinical features and outcomes of patients with posterior reversible encephalopathy syndrome (PRES), the risk factors of PRES-related intracranial hemorrhage (ICH), and all-cause mortality in patients with systemic lupus erythematosus (SLE). Methods Twenty-six episodes of PRES were identified in 23 SLE patients, using an electronic medical records database of 3,746 SLE patients. Results The prevalence of PRES was 0.69% among SLE patients. The scores of the SLE Disease Activity Index without neurologic descriptors (SLEDAI-N) were significantly elevated from baseline for a mean of 3.3 during PRES (P = 0.009). Rapidly deteriorating renal function, pulmonary hemorrhage, thrombotic microangiopathy, macrophage activation syndrome, or multiple organ dysfunction syndrome appeared during 65.4% of episodes. In 16 episodes, patients completely recovered from PRES-related symptoms within a median of 7 days. Visual impairment was reversed within 2 days in 8 of 15 patients, but impairment in other patients was protracted for up to 4 months, especially when ICH was present. Hypoalbuminemia (3; OR 21, 95% CI 1.27-346.93) were risk factors for PRES-related ICH. Patients with SLEDAI-N scores >18 during a PRES attack had significantly higher mortality rates than did patients with SLEDAI-N scores ≤18 (P = 0.009 by log rank test). Conclusion PRES frequently occurs during active SLE with multiple complications. Hypoalbuminemia and thrombocytopenia may contribute to PRES-related ICH. The extraneurologic disease activity of lupus during PRES may influence the mortality rate of SLE patients.

Original languageEnglish
Pages (from-to)1766-1774
Number of pages9
JournalArthritis Care and Research
Volume65
Issue number11
DOIs
Publication statusPublished - Nov 2013

Fingerprint

Posterior Leukoencephalopathy Syndrome
Systemic Lupus Erythematosus
Intracranial Hemorrhages
Nervous System
Hypoalbuminemia
Mortality
Macrophage Activation Syndrome
Thrombotic Microangiopathies
Multiple Organ Failure
Electronic Health Records
Vision Disorders
Thrombocytopenia

ASJC Scopus subject areas

  • Rheumatology

Cite this

Clinical features and outcomes of posterior reversible encephalopathy syndrome in patients with systemic lupus erythematosus. / Lai, Chien Chih; Chen, Wei Sheng; Chang, Yu Sheng; Wang, Shu Hung; Huang, Chun Jui; Guo, Wan Yuo; Yang, Wu Chang; Huang, De Feng.

In: Arthritis Care and Research, Vol. 65, No. 11, 11.2013, p. 1766-1774.

Research output: Contribution to journalArticle

Lai, Chien Chih ; Chen, Wei Sheng ; Chang, Yu Sheng ; Wang, Shu Hung ; Huang, Chun Jui ; Guo, Wan Yuo ; Yang, Wu Chang ; Huang, De Feng. / Clinical features and outcomes of posterior reversible encephalopathy syndrome in patients with systemic lupus erythematosus. In: Arthritis Care and Research. 2013 ; Vol. 65, No. 11. pp. 1766-1774.
@article{77b777ad910943be8201145ff006ffc7,
title = "Clinical features and outcomes of posterior reversible encephalopathy syndrome in patients with systemic lupus erythematosus",
abstract = "Objective To analyze the clinical features and outcomes of patients with posterior reversible encephalopathy syndrome (PRES), the risk factors of PRES-related intracranial hemorrhage (ICH), and all-cause mortality in patients with systemic lupus erythematosus (SLE). Methods Twenty-six episodes of PRES were identified in 23 SLE patients, using an electronic medical records database of 3,746 SLE patients. Results The prevalence of PRES was 0.69{\%} among SLE patients. The scores of the SLE Disease Activity Index without neurologic descriptors (SLEDAI-N) were significantly elevated from baseline for a mean of 3.3 during PRES (P = 0.009). Rapidly deteriorating renal function, pulmonary hemorrhage, thrombotic microangiopathy, macrophage activation syndrome, or multiple organ dysfunction syndrome appeared during 65.4{\%} of episodes. In 16 episodes, patients completely recovered from PRES-related symptoms within a median of 7 days. Visual impairment was reversed within 2 days in 8 of 15 patients, but impairment in other patients was protracted for up to 4 months, especially when ICH was present. Hypoalbuminemia (3; OR 21, 95{\%} CI 1.27-346.93) were risk factors for PRES-related ICH. Patients with SLEDAI-N scores >18 during a PRES attack had significantly higher mortality rates than did patients with SLEDAI-N scores ≤18 (P = 0.009 by log rank test). Conclusion PRES frequently occurs during active SLE with multiple complications. Hypoalbuminemia and thrombocytopenia may contribute to PRES-related ICH. The extraneurologic disease activity of lupus during PRES may influence the mortality rate of SLE patients.",
author = "Lai, {Chien Chih} and Chen, {Wei Sheng} and Chang, {Yu Sheng} and Wang, {Shu Hung} and Huang, {Chun Jui} and Guo, {Wan Yuo} and Yang, {Wu Chang} and Huang, {De Feng}",
year = "2013",
month = "11",
doi = "10.1002/acr.22047",
language = "English",
volume = "65",
pages = "1766--1774",
journal = "Arthritis and Rheumatology",
issn = "2326-5191",
publisher = "John Wiley and Sons Ltd",
number = "11",

}

TY - JOUR

T1 - Clinical features and outcomes of posterior reversible encephalopathy syndrome in patients with systemic lupus erythematosus

AU - Lai, Chien Chih

AU - Chen, Wei Sheng

AU - Chang, Yu Sheng

AU - Wang, Shu Hung

AU - Huang, Chun Jui

AU - Guo, Wan Yuo

AU - Yang, Wu Chang

AU - Huang, De Feng

PY - 2013/11

Y1 - 2013/11

N2 - Objective To analyze the clinical features and outcomes of patients with posterior reversible encephalopathy syndrome (PRES), the risk factors of PRES-related intracranial hemorrhage (ICH), and all-cause mortality in patients with systemic lupus erythematosus (SLE). Methods Twenty-six episodes of PRES were identified in 23 SLE patients, using an electronic medical records database of 3,746 SLE patients. Results The prevalence of PRES was 0.69% among SLE patients. The scores of the SLE Disease Activity Index without neurologic descriptors (SLEDAI-N) were significantly elevated from baseline for a mean of 3.3 during PRES (P = 0.009). Rapidly deteriorating renal function, pulmonary hemorrhage, thrombotic microangiopathy, macrophage activation syndrome, or multiple organ dysfunction syndrome appeared during 65.4% of episodes. In 16 episodes, patients completely recovered from PRES-related symptoms within a median of 7 days. Visual impairment was reversed within 2 days in 8 of 15 patients, but impairment in other patients was protracted for up to 4 months, especially when ICH was present. Hypoalbuminemia (3; OR 21, 95% CI 1.27-346.93) were risk factors for PRES-related ICH. Patients with SLEDAI-N scores >18 during a PRES attack had significantly higher mortality rates than did patients with SLEDAI-N scores ≤18 (P = 0.009 by log rank test). Conclusion PRES frequently occurs during active SLE with multiple complications. Hypoalbuminemia and thrombocytopenia may contribute to PRES-related ICH. The extraneurologic disease activity of lupus during PRES may influence the mortality rate of SLE patients.

AB - Objective To analyze the clinical features and outcomes of patients with posterior reversible encephalopathy syndrome (PRES), the risk factors of PRES-related intracranial hemorrhage (ICH), and all-cause mortality in patients with systemic lupus erythematosus (SLE). Methods Twenty-six episodes of PRES were identified in 23 SLE patients, using an electronic medical records database of 3,746 SLE patients. Results The prevalence of PRES was 0.69% among SLE patients. The scores of the SLE Disease Activity Index without neurologic descriptors (SLEDAI-N) were significantly elevated from baseline for a mean of 3.3 during PRES (P = 0.009). Rapidly deteriorating renal function, pulmonary hemorrhage, thrombotic microangiopathy, macrophage activation syndrome, or multiple organ dysfunction syndrome appeared during 65.4% of episodes. In 16 episodes, patients completely recovered from PRES-related symptoms within a median of 7 days. Visual impairment was reversed within 2 days in 8 of 15 patients, but impairment in other patients was protracted for up to 4 months, especially when ICH was present. Hypoalbuminemia (3; OR 21, 95% CI 1.27-346.93) were risk factors for PRES-related ICH. Patients with SLEDAI-N scores >18 during a PRES attack had significantly higher mortality rates than did patients with SLEDAI-N scores ≤18 (P = 0.009 by log rank test). Conclusion PRES frequently occurs during active SLE with multiple complications. Hypoalbuminemia and thrombocytopenia may contribute to PRES-related ICH. The extraneurologic disease activity of lupus during PRES may influence the mortality rate of SLE patients.

UR - http://www.scopus.com/inward/record.url?scp=84887054128&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887054128&partnerID=8YFLogxK

U2 - 10.1002/acr.22047

DO - 10.1002/acr.22047

M3 - Article

C2 - 23687067

AN - SCOPUS:84887054128

VL - 65

SP - 1766

EP - 1774

JO - Arthritis and Rheumatology

JF - Arthritis and Rheumatology

SN - 2326-5191

IS - 11

ER -