Drs. Chang and Liu contributed equally to this work.
Systemic Lupus Erythematosus
Increased Risk of Subarachnoid Hemorrhage in Patients With Systemic Lupus Erythematosus: A Nationwide Population-Based Study
Article first published online: 28 MAR 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 4, pages 601–606, April 2013
How to Cite
Chang, Y.-S., Liu, C.-J., Chen, W.-S., Lai, C.-C., Wang, S.-H., Chen, T.-J., Tzeng, C.-H., Tsai, C.-Y. and Wang, S.-J. (2013), Increased Risk of Subarachnoid Hemorrhage in Patients With Systemic Lupus Erythematosus: A Nationwide Population-Based Study. Arthritis Care Res, 65: 601–606. doi: 10.1002/acr.21846
- Issue published online: 28 MAR 2013
- Article first published online: 28 MAR 2013
- Accepted manuscript online: 10 SEP 2012 09:25AM EST
- Manuscript Accepted: 27 AUG 2012
- Manuscript Received: 28 APR 2012
- Taiwan National Science Council. Grant Numbers: 100-2314-B-010-019-MY2, 100-2314-B-010-018-MY3
- Taipei Veterans General Hospital. Grant Numbers: VGHUST101-G7-1-1, V101C-106, V101E7-003
- National Science Council support for the Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taiwan. Grant Number: NSC grant 100-2911-I-008-001
- Brain Research Center, National Yang-Ming University
- Ministry of Education, Aim for the Top University Plan
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.
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.
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.
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.