Shin-Joe Yeh1, Jiann-Shing Jeng1, Sung-Chun Tang1, Chung-Hsiang Liu2, Shih-Pin Hsu3, Chih-Hung Chen4, Li-Ming Lien5, Huey-Juan Lin6, Chiu-Mei Chen7, Ruey-Tay Lin8, Siu-Pak Lee9, Ching-Huang Lin10, Chung-Hsin Yeh11, Yu Sun12, Ming-Hui Sun13, Jiu-Haw Yin14, Che-Chen Lin15, Chi-Pang Wen16, Li-Kai Tsai17, Fung-Chang Sung18, Chung Y Hsu19. 1. Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC. 2. Department of Neurology, China Medical University Hospital, Taichung, Taiwan, ROC. 3. Department of Neurology, E Da Hospital, Kaohsiung, Taiwan, ROC. 4. Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan, ROC. 5. Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan, ROC. 6. Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan, ROC. 7. Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC. 8. Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC. 9. Department of Neurology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC. 10. Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC. 11. Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan, ROC. 12. Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan, ROC. 13. Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan, ROC. 14. Department of Neurology, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC. 15. Department of Public Health, China Medical University, Taichung, Taiwan, ROC. 16. Institute of Population Science, National Health Research Institute, Miaoli, Taiwan, ROC. 17. Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC. Electronic address: milikai@ntuh.gov.tw. 18. Department of Public Health, China Medical University, Taichung, Taiwan, ROC. Electronic address: fcsung1008@yahoo.com. 19. Graduate Institute of Clinical Medical Science, China Medical University and Hospital, Taichung, Taiwan, ROC.
Abstract
OBJECTIVES: The relationship between low estimated glomerular filtration rate (eGFR) and the outcome of ischemic stroke remains controversial, despite the close association between kidney dysfunction and atherosclerosis. METHODS: This study conducted subgroup analysis using data from the prospective Taiwan Stroke Registry to investigate the relationship between eGFR at the time of admission and 6-month functional outcomes in patients with the large artery atherosclerotic (LAA) subtype of acute ischemic stroke. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and outcomes were defined as modified Rankin Scale and mortality status at 6 months post stroke. RESULTS: Of the 8052 patients with the LAA subtype of acute ischemic stroke in this study, 3312 (41.1%) had eGFR <60 mL/min/1.73 m(2). The adjusted odds ratios of worse functional outcomes following a stroke were 1.10 (95% confidence interval [CI], 0.95-1.28), 1.60 (95% CI, 1.22-2.11) and 1.60 (95% CI, 1.10-2.33) in patients with eGFR 30-59, 15-29, and <15 as compared with those with eGFR 60-119 mL/min/1.73 m(2), respectively. Increased risk of mortality was closely and independently related to high NIHSS scores and low eGFR levels. Stroke severity and eGFR were also synergistically related to 6-month mortality, with an adjusted hazard ratio of 21.19 (95% CI, 9.69-46.35) in patients with NIHSS >15 and eGFR <15 mL/min/1.73 m(2), compared with those with NIHSS 0-5 and eGFR 60-119 mL/min/1.73 m(2). CONCLUSIONS: Low eGFR was significantly and independently associated with 6-month functional outcomes and mortality in patients with the LAA subtype of acute ischemic stroke. The deleterious relationship between low eGFR levels and mortality following stroke was exacerbated by its synergistic association with stroke severity.
OBJECTIVES: The relationship between low estimated glomerular filtration rate (eGFR) and the outcome of ischemic stroke remains controversial, despite the close association between kidney dysfunction and atherosclerosis. METHODS: This study conducted subgroup analysis using data from the prospective Taiwan Stroke Registry to investigate the relationship between eGFR at the time of admission and 6-month functional outcomes in patients with the large artery atherosclerotic (LAA) subtype of acute ischemic stroke. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and outcomes were defined as modified Rankin Scale and mortality status at 6 months post stroke. RESULTS: Of the 8052 patients with the LAA subtype of acute ischemic stroke in this study, 3312 (41.1%) had eGFR <60 mL/min/1.73 m(2). The adjusted odds ratios of worse functional outcomes following a stroke were 1.10 (95% confidence interval [CI], 0.95-1.28), 1.60 (95% CI, 1.22-2.11) and 1.60 (95% CI, 1.10-2.33) in patients with eGFR 30-59, 15-29, and <15 as compared with those with eGFR 60-119 mL/min/1.73 m(2), respectively. Increased risk of mortality was closely and independently related to high NIHSS scores and low eGFR levels. Stroke severity and eGFR were also synergistically related to 6-month mortality, with an adjusted hazard ratio of 21.19 (95% CI, 9.69-46.35) in patients with NIHSS >15 and eGFR <15 mL/min/1.73 m(2), compared with those with NIHSS 0-5 and eGFR 60-119 mL/min/1.73 m(2). CONCLUSIONS: Low eGFR was significantly and independently associated with 6-month functional outcomes and mortality in patients with the LAA subtype of acute ischemic stroke. The deleterious relationship between low eGFR levels and mortality following stroke was exacerbated by its synergistic association with stroke severity.