期刊
JOURNAL OF CLINICAL NEUROLOGY
卷 11, 期 1, 页码 73-79出版社
KOREAN NEUROLOGICAL ASSOC
DOI: 10.3988/jcn.2015.11.1.73
关键词
chronic kidney disease; functional outcome; mortality; stroke
资金
- Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea [HI10C2020]
Background and Purpose Chronic kidney disease (CKD) is an established risk factor for numerous cardiovascular diseases including stroke. The relationship between the baseline estimated glomerular filtration rate (eGFR) and clinical 3-month outcomes in patients with acute ischemic stroke were evaluated in this study. Methods This was a prospective cohort study involving a hospital-based stroke registry; 1373 patients with acute ischemic stroke were enrolled. Patients were divided into the following four groups according their eGFR (calculated using the CKD Epidemiology Collaboration equations): >= 60, 45-59, 30-44, and <30 mL/min/1.73 m(2). The primary endpoint of poor functional outcome was defined as 3-month death or dependency (modified Rankin Scale score >= 3); secondary endpoints were neurological deterioration (increase in National Institutes of Health Stroke Severity score of >= 4 at discharge compared to baseline) during hospitalization and in-hospital mortality. Results The overall eGFR was 84.5 +/- 20.8 mL/min/1.73 m(2) (mean +/- SD). The distribution of baseline renal impairment was as follows: 1,218, 82, 40, and 33 patients had eGFRs of >= 60, 45-59, 30-44, and <30 mL/min/1.73 m2, respectively. At 3 months after the stroke, 476(34.7%) patients exhibited poor functional outcome. Furthermore, a poor functional outcome occurred more frequently with increasingly advanced stages of CKD (rates of 31.9%, 53.7%, 55.0%, and 63.6% for CKD stages 1/2, 3a, 3b, and 4/5, respectively; p<0.001). Multivariate analysis revealed that a baseline eGFR of <30 mL/min/1.73m(2) increased the risk of a poor functional outcome by 2.37-fold (p=0.047). In addition, baseline renal dysfunction was closely associated with neurological deterioration during hospitalization and with in-hospital mortality. Conclusions A low baseline eGFR was strongly predictive of both poor functional outcome at 3 months after ischemic stroke and neurological deterioration/mortality during hospitalization.
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