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

Arthritis Care Res (Hoboken) 2013 Nov;65(11):1766-74

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 (<20 gm/liter; odds ratio [OR] 30, 95% confidence interval [95% CI] 2.04–441.84) and thrombocytopenia (<30,000/mm(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 extra neurologic disease activity of lupus during PRES may influence the mortality rate of SLE patients.

Download full-text PDF

Source
http://dx.doi.org/10.1002/acr.22047DOI Listing
November 2013
30 Reads

Publication Analysis

Top Keywords

sle patients
8
reversible encephalopathy
8
patients
8
patients systemic
8
lupus erythematosus
8
posterior reversible
8
systemic lupus
8
features outcomes
8
clinical features
8
pres 0009
4
0009 rapidly
4
sledai-n elevated
4
baseline pres
4
rapidly deteriorating
4
elevated baseline
4
deteriorating renal
4
hemorrhage thrombotic
4
thrombotic microangiopathy
4
pulmonary hemorrhage
4
function pulmonary
4

References

(Supplied by CrossRef)
Hypertensive disorders of pregnancy
Marik et al.
Postgrad Med 2009
Diffusion-weighted MR imaging in hypertensive encephalopathy: clues to pathogenesis
Schwartz et al.
AJNR Am J Neuroradiol 1998
Posterior reversible encephalopathy syndrome in infection, sepsis, and shock
Bartynski et al.
AJNR Am J Neuroradiol 2006
Neurotoxicity of immunosuppressive drugs
Wijdicks et al.
Liver Transpl 2001
Reversible posterior leukoencephalopathy syndrome caused by blood transfusion: a case report
Huang et al.
Acta Neurol Taiwan 2008

Similar Publications