Department of Medicine, Cook County Hospital, Chicago, IL.
From the Division of Rheumatology, Rush University Medical Center.
J Clin Rheumatol. 2021 Dec 1;27(8):e391-e394. doi: 10.1097/RHU.0000000000001470.
Posterior reversible encephalopathy syndrome (PRES) is an acute neurological syndrome. There are many reports of PRES occurring in the setting of rheumatic diseases. However, it remains uncertain whether rheumatic diseases are truly a risk factor for PRES, as the literature consists of case reports and small clinical series. Here, we evaluated the relationship between PRES and the rheumatic diseases, using a large population-based data set as the reference.
We conducted a medical records review of hospitalizations in the United States during 2016 with a diagnosis of PRES. Hospitalizations were selected from the National Inpatient Sample. International Classification of Diseases, 10th Revision, Clinical Modification codes were used to identify rheumatic diseases. A multivariate logistic regression analysis was used to calculate odds ratios (ORs) for the association of PRES and rheumatic diseases.
There were 3125 hospitalizations that had a principal billing diagnosis of PRES. Multivariate logistic regression revealed the multiple independent associations with PRES. The demographic and nonrheumatic associations included acute renal failure (OR, 1.52), chronic renal failure (OR, 12.1), female (OR, 2.28), hypertension (OR, 8.73), kidney transplant (OR, 1.97), and preeclampsia/eclampsia (OR, 11.45). Rheumatic associations with PRES included antineutrophil cytoplasmic antibody-associated vasculitis (OR, 9.31), psoriatic arthritis (OR, 4.61), systemic sclerosis (OR, 6.62), systemic lupus erythematosus (SLE) nephritis (OR, 7.53), and SLE without nephritis (OR, 2.38).
This analysis represents the largest sample to date to assess PRES hospitalizations. It confirms that several rheumatic diseases are associated with PRES, including antineutrophil cytoplasmic antibody-associated vasculitis, systemic sclerosis, SLE, and psoriatic arthritis. Acute and unexplained central nervous system symptoms in these patient populations should prompt consideration of PRES.
后部可逆性脑病综合征（PRES）是一种急性神经系统综合征。有许多关于风湿性疾病伴发 PRES 的报道。然而，由于文献主要由病例报告和小的临床系列组成，风湿性疾病是否确实是 PRES 的危险因素仍不确定。在这里，我们使用大型基于人群的数据集作为参考，评估 PRES 与风湿性疾病之间的关系。
我们对 2016 年美国住院患者进行了病历回顾，这些患者的诊断为 PRES。住院患者从国家住院患者样本中选择。使用国际疾病分类第 10 次修订版临床修正代码来识别风湿性疾病。多变量逻辑回归分析用于计算 PRES 与风湿性疾病关联的比值比（OR）。
共有 3125 例住院患者的主要计费诊断为 PRES。多变量逻辑回归显示了与 PRES 多个独立相关。与非风湿性疾病相关的因素包括急性肾衰竭（OR，1.52）、慢性肾衰竭（OR，12.1）、女性（OR，2.28）、高血压（OR，8.73）、肾移植（OR，1.97）和子痫前期/子痫（OR，11.45）。与 PRES 相关的风湿性疾病包括抗中性粒细胞胞浆抗体相关性血管炎（OR，9.31）、银屑病关节炎（OR，4.61）、系统性硬化症（OR，6.62）、系统性红斑狼疮肾炎（OR，7.53）和无肾炎的系统性红斑狼疮（OR，2.38）。
该分析是迄今为止评估 PRES 住院患者的最大样本。它证实了几种风湿性疾病与 PRES 相关，包括抗中性粒细胞胞浆抗体相关性血管炎、系统性硬化症、系统性红斑狼疮和银屑病关节炎。这些患者人群中出现急性和不明原因的中枢神经系统症状应促使考虑 PRES。
