Clinical profile and risk factors of posterior reversible encephalopathy syndrome in systemic lupus erythematosus: A case-control study

Objectives To investigate the clinical profile and risk factors of Posterior Reversible Encephalopathy Syndrome (PRES) in patients with Systemic Lupus Erythematosus (SLE). Methods In this retrospective study, the SLE patients admitted with PRES in the Department of Clinical Immunology and Rheumatology, IPGME&R, Kolkata, India from January 1, 2017 to January 31, 2024, were identified. Fifty-three control participants with neuropsychiatric symptoms as per the 1999 American College of Rheumatology case definition criteria were selected from the departmental SLE cohort. Results 26 episodes of PRES were identified in 25 patients. Seizures (88.46%) and headaches (53.85%) were the commonest presenting manifestations with the occipital (96.15%) and parietal lobes (84.62%) being the commonly involved sites. Nephritis (96.15% vs 60.38%, p = 0.001), hypertension at PRES onset (76.92% vs 18.87%, p = 0.000), Direct Coomb’s test (DCT) positivity (50.00% vs 20.75%, p = 0.008), high extra-neurological disease activity (SELENA-SLEDAI – N : 20.62±8.77 vs 14.15 ± 5.51, p = 0.002), lupus enteritis (15.38% vs 1.89%, p = 0.038), and neutrophilia (73.08% vs 20.75%, p = 0.000) were identified as risk factors for PRES on univariate analysis. Multivariate analysis found hypertension [ p = 0.014], DCT positivity ( p = 0.013), neutrophilia ( p = 0.025), and lupus enteritis (0.038) as independent risk factors. The presence of U1RNP/Sm and prior thrombotic events were found to be protective against PRES on univariate analysis. Conclusion PRES in SLE in our study was associated with high extra-neurological disease activity. Hypertension, DCT positivity, neutrophilia, and lupus enteritis were identified as important risk factors for the condition.