Aryandhito Widhi Nugroho1,2,3, Hisatomi Arima4,5, Itsuko Miyazawa6, Takako Fujii1, Naomi Miyamatsu7, Yoshihisa Sugimoto8,9, Satoru Nagata9, Masaru Komori10, Naoyuki Takashima5, Yoshikuni Kita5,11, Katsuyuki Miura3,5, Kazuhiko Nozaki1,3. 1. Department of Neurosurgery, Shiga University of Medical Science. 2. Department of Neurosurgery, University of Indonesia. 3. Center for Epidemiologic Research in Asia, Shiga University of Medical Science. 4. Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University. 5. Department of Public Health, Shiga University of Medical Science. 6. Department of Medicine, Shiga University of Medical Science. 7. Department of Clinical Nursing, Shiga University of Medical Science. 8. Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science. 9. Department of Medical Informatics and Biomedical Engineering, Shiga University of Medical Science. 10. Department of Fundamental Biosciences, Shiga University of Medical Science. 11. Department of Nursing Science, Tsuruga Nursing University.
Abstract
AIM: Although renal dysfunction has been identified as a novel risk factor affecting stroke prognosis, few have analyzed the association within large-scale population-based setting, using wide-range estimated glomerular filtration rate (eGFR) category. We aimed to determine the association of admission eGFR with acute stroke outcomes using data from a registry established in Shiga Prefecture, Japan. METHODS: Following exclusion of patients younger than 18 years, with missing serum creatinine data, and with onset more than 7 days prior to admission, 2,813 acute stroke patients registered in the Shiga Stroke Registry year 2011 were included in the final analysis. The Japanese Society of Nephrology equation was used to estimate GFR. Multivariable logistic regression was performed to analyze the association of eGFR with all-cause in-hospital death (modified Rankin Scale [mRS] 6), and at-discharge death/disability (mRS 2-6). Separate analyses were conducted within stroke subtypes. RESULTS: Compared to eGFR 60-89 mL/min/1.73 m2, adjusted odds ratios (ORs) and 95% confidence interval [95% CI] for in-hospital death (in the order of eGFR ＜45, 45-59, and ≥90 mL/min/1.73 m2) were 1.54 [1.04-2.27], 1.07 [0.72-1.58], and 1.04 [0.67-1.59]. Likewise, adjusted ORs [95% CI] for at-discharge death/disability were 1.54 [1.02-2.32], 0.97 [0.73-1.31], and 1.48 [1.06-2.05]. Similar pattern was further evident in the eGFR ＜45 mL/min/1.73 m2 group for both outcomes within acute ischemic stroke patients. CONCLUSIONS: Our study has ascertained that in acute stroke, particularly ischemic stroke, low eGFR was significantly associated with in-hospital death and at-discharge death/disability. Additionally, high eGFR was found to be associated with at-discharge death/disability.
AIM: Although renal dysfunction has been identified as a novel risk factor affecting stroke prognosis, few have analyzed the association within large-scale population-based setting, using wide-range estimated glomerular filtration rate (eGFR) category. We aimed to determine the association of admission eGFR with acute stroke outcomes using data from a registry established in Shiga Prefecture, Japan. METHODS: Following exclusion of patients younger than 18 years, with missing serum creatinine data, and with onset more than 7 days prior to admission, 2,813 acute strokepatients registered in the Shiga Stroke Registry year 2011 were included in the final analysis. The Japanese Society of Nephrology equation was used to estimate GFR. Multivariable logistic regression was performed to analyze the association of eGFR with all-cause in-hospital death (modified Rankin Scale [mRS] 6), and at-discharge death/disability (mRS 2-6). Separate analyses were conducted within stroke subtypes. RESULTS: Compared to eGFR 60-89 mL/min/1.73 m2, adjusted odds ratios (ORs) and 95% confidence interval [95% CI] for in-hospital death (in the order of eGFR ＜45, 45-59, and ≥90 mL/min/1.73 m2) were 1.54 [1.04-2.27], 1.07 [0.72-1.58], and 1.04 [0.67-1.59]. Likewise, adjusted ORs [95% CI] for at-discharge death/disability were 1.54 [1.02-2.32], 0.97 [0.73-1.31], and 1.48 [1.06-2.05]. Similar pattern was further evident in the eGFR ＜45 mL/min/1.73 m2 group for both outcomes within acute ischemic strokepatients. CONCLUSIONS: Our study has ascertained that in acute stroke, particularly ischemic stroke, low eGFR was significantly associated with in-hospital death and at-discharge death/disability. Additionally, high eGFR was found to be associated with at-discharge death/disability.
Authors: Elizabeth Mostofsky; Gregory A Wellenius; Amit Noheria; Emily B Levitan; Mary R Burger; Gottfried Schlaug; Murray A Mittleman Journal: Cerebrovasc Dis Date: 2009-05-20 Impact factor: 2.762