Increased risk of subarachnoid hemorrhage in patients with systemic lupus erythematosus: A nationwide population-based study

Yu Sheng Chang, Chia Jen Liu, Wei Sheng Chen, Chien Chih Lai, Shu Hung Wang, Tzeng Ji Chen, Cheng Hwai Tzeng, Chang Youh Tsai, Shuu Jiun Wang

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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 population-based 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 = 0.007). Age (hazard ratio [HR] 1.03, 95% confidence interval [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 a mean daily steroid dose >10 mg of prednisolone or equivalent (HR 4.36, 95% CI 2.19-8.68) were independent risk factors for the new onset of SAH. 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.

Original languageEnglish
Pages (from-to)601-606
Number of pages6
JournalArthritis Care and Research
Volume65
Issue number4
DOIs
Publication statusPublished - Apr 2013

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Subarachnoid Hemorrhage
Systemic Lupus Erythematosus
Population
Erythrocyte Transfusion
Incidence
National Health Programs
Prednisolone
Taiwan
Proportional Hazards Models
Blood Platelets
Steroids
Databases
Mortality

ASJC Scopus subject areas

  • Rheumatology

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Increased risk of subarachnoid hemorrhage in patients with systemic lupus erythematosus : A nationwide population-based study. / Chang, Yu Sheng; Liu, Chia Jen; Chen, Wei Sheng; Lai, Chien Chih; Wang, Shu Hung; Chen, Tzeng Ji; Tzeng, Cheng Hwai; Tsai, Chang Youh; Wang, Shuu Jiun.

In: Arthritis Care and Research, Vol. 65, No. 4, 04.2013, p. 601-606.

Research output: Contribution to journalArticle

Chang, Yu Sheng ; Liu, Chia Jen ; Chen, Wei Sheng ; Lai, Chien Chih ; Wang, Shu Hung ; Chen, Tzeng Ji ; Tzeng, Cheng Hwai ; Tsai, Chang Youh ; Wang, Shuu Jiun. / Increased risk of subarachnoid hemorrhage in patients with systemic lupus erythematosus : A nationwide population-based study. In: Arthritis Care and Research. 2013 ; Vol. 65, No. 4. pp. 601-606.
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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 population-based 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 = 0.007). Age (hazard ratio [HR] 1.03, 95{\%} confidence interval [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 a mean daily steroid dose >10 mg of prednisolone or equivalent (HR 4.36, 95{\%} CI 2.19-8.68) were independent risk factors for the new onset of SAH. 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.",
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T1 - Increased risk of subarachnoid hemorrhage in patients with systemic lupus erythematosus

T2 - A nationwide population-based study

AU - Chang, Yu Sheng

AU - Liu, Chia Jen

AU - Chen, Wei Sheng

AU - Lai, Chien Chih

AU - Wang, Shu Hung

AU - Chen, Tzeng Ji

AU - Tzeng, Cheng Hwai

AU - Tsai, Chang Youh

AU - Wang, Shuu Jiun

PY - 2013/4

Y1 - 2013/4

N2 - 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 population-based 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 = 0.007). Age (hazard ratio [HR] 1.03, 95% confidence interval [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 a mean daily steroid dose >10 mg of prednisolone or equivalent (HR 4.36, 95% CI 2.19-8.68) were independent risk factors for the new onset of SAH. 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.

AB - 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 population-based 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 = 0.007). Age (hazard ratio [HR] 1.03, 95% confidence interval [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 a mean daily steroid dose >10 mg of prednisolone or equivalent (HR 4.36, 95% CI 2.19-8.68) were independent risk factors for the new onset of SAH. 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.

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