I-Kuan Wang1, Li-Ming Lien2, Jiunn-Tay Lee3, Chung-Hsiang Liu4, Chih-Hung Chen5, Ching-Huang Lin6, Jiann-Shing Jeng7, Chaur-Jong Hu8, Tzung-Hai Yen9, Sien-Tsong Chen10, Hou-Chang Chiu11, I-Ju Tsai12, Fung-Chang Sung13, Chung Y Hsu14. 1. Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, China Medical University Hospital, Taichung, Taiwan. 2. Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital and Taipei Medical University College of Medicine, Taiwan. 3. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. 4. Department of Neurology, China Medical University Hospital, Taichung, Taiwan. 5. Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Stroke Center, National Cheng Kung University Hospital, Tainan, Taiwan. 6. Department of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. 7. Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. 8. Department of Neurology, College of Medicine, Taipei Medical University Shuang-Ho Hospital, Taiwan. 9. Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan. 10. Chang Gung University and Memorial Hospital, Linkou, Taiwan. 11. Neurology, Shin Kong WHS Memorial Hospital, Taipei, Taiwan. 12. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan. 13. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Department of Health Services Administration, China Medical University College of Public Health, Taichung 404, Taiwan. Electronic address: fcsung1008@yahoo.com. 14. Department of Neurology, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Science, College of Medicine, China Medical University, Taiwan.
Abstract
BACKGROUND AND AIMS: This study investigated risks of short-term (1 and 3 months) and long-term (1-year) recurrent stroke associated with glomerular filtration rate (eGFR) in patients with acute ischemic stroke. METHODS: From the Taiwan Stroke Registry data, we identified 45,876 acute ischemic stroke patients from April 2006 to April 2014 and classified them into 4 groups based on the eGFR at admission: ≥ 90, 60-89, 30-59, and <30 mL/min/1.73 m2 or on dialysis. The risks of 1-month, 3-month and 1-year recurrent stroke related to the eGFR levels were investigated. RESULTS: Both the risks of short-term and long-term recurrent stroke increased as the eGFR levels declined. The 1-month recurrent incidence rates increased steadily from 0.54 to 0.59, 0.84 and 0.89 per 1000 person-days, as the eGFR declined from ≥90 to 60-89, 30-59, and <30 mL/min/1.73 m2 or on dialysis, respectively. Compared to patients with eGFR ≥90 mL/min/1.73 m2, the adjusted subhazard ratio of 1-month recurrent stroke decreased from 1.69 (95% confidence interval (CI) = 1.24-2.31) for patients with eGFR < 30 mL/min/1.73 m2 or on dialysis to 1.14 (95% CI = 0.91-1.43) for patients with eGFRs of 60-89 mL/min/1.73 m2, considering the competing risk of deaths. Similar patterns were also observed for the adjusted HRs of 3-month and 1-year recurrent stroke, but with reduced hazard values, by the corresponding eGFR levels. CONCLUSIONS: There is an independent graded association between an increased risk of recurrent stroke and declining eGFR levels in patients with acute ischemic stroke.
BACKGROUND AND AIMS: This study investigated risks of short-term (1 and 3 months) and long-term (1-year) recurrent stroke associated with glomerular filtration rate (eGFR) in patients with acute ischemic stroke. METHODS: From the Taiwan Stroke Registry data, we identified 45,876 acute ischemic strokepatients from April 2006 to April 2014 and classified them into 4 groups based on the eGFR at admission: ≥ 90, 60-89, 30-59, and <30 mL/min/1.73 m2 or on dialysis. The risks of 1-month, 3-month and 1-year recurrent stroke related to the eGFR levels were investigated. RESULTS: Both the risks of short-term and long-term recurrent stroke increased as the eGFR levels declined. The 1-month recurrent incidence rates increased steadily from 0.54 to 0.59, 0.84 and 0.89 per 1000 person-days, as the eGFR declined from ≥90 to 60-89, 30-59, and <30 mL/min/1.73 m2 or on dialysis, respectively. Compared to patients with eGFR ≥90 mL/min/1.73 m2, the adjusted subhazard ratio of 1-month recurrent stroke decreased from 1.69 (95% confidence interval (CI) = 1.24-2.31) for patients with eGFR < 30 mL/min/1.73 m2 or on dialysis to 1.14 (95% CI = 0.91-1.43) for patients with eGFRs of 60-89 mL/min/1.73 m2, considering the competing risk of deaths. Similar patterns were also observed for the adjusted HRs of 3-month and 1-year recurrent stroke, but with reduced hazard values, by the corresponding eGFR levels. CONCLUSIONS: There is an independent graded association between an increased risk of recurrent stroke and declining eGFR levels in patients with acute ischemic stroke.