The challenging clinical dilemma of posterior reversible encephalopathy syndrome in systemic lupus erythematosus.

Abstract

Posterior reversible encephalopathy syndrome (PRES) in systemic lupus erythematosus (SLE) is achallenging clinical dilemma. Aretrospective single-center study was performed to investigate the clinical features, risk factors, outcomes, and clinical determinants of the prognosis of PRES in SLE. Aretrospective study was performed from January2015 to December2020. 19episodes of lupus PRES and 19episodes of non-lupus PRES were identified. 38cases of patients presenting with neuropsychiatric lupus (NPSLE) hospitalized during the same period were selected as controls. Survival status was acquired via outpatient and telephone follow-up in December2022. The clinical neurological presentation of PRES in lupus patients was similar to that of the non-SLE-related PRES and NPSLE populations. Nephritis-induced hypertension is the predominant trigger of PRES in SLE. Disease flare and renal failure-triggered PRES were identified in half of the patients with SLE. The mortality rate of lupus-related PRES during the 2‑year follow-up was 15.8%, the same as that of NPSLE. For patients with lupus-related PRES, multivariate analysis indicated that high diastolic blood pressure (OR =1.762, 95% CI: 1.031 ~ 3.012, p = 0.038), renal involvement (OR = 3.456, 95% CI: 0.894 ~ 14.012, p = 0.049), and positive proteinuria (OR = 1.231, 95% CI: 1.003 ~ 1.511, p = 0.047) were independent risk factors compared to NPSLE. Astrong connection between the absolute counts of Tand/or Bcells and prognosis in lupus patients with neurological manifestations was found (p < 0.05). The lower the counts of Tand/or Bcells, the worse the prognosis. Lupus patients with renal involvement and disease activity are more likely to develop PRES. The mortality rate of lupus-related PRES is similar to that of NPSLE. Focusing on immune balance might reduce mortality.