Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota; Department of Nephrology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
J Stroke Cerebrovasc Dis. 2013 Nov;22(8):e354-9. doi: 10.1016/j.jstrokecerebrovasdis.2013.03.016. Epub 2013 Apr 28.
To determine the outcomes of dialysis-dependent renal failure patients who had ischemic stroke and were treated with intravenous (IV) thrombolytics in the United States.
We analyzed the data from Nationwide Inpatient Sample (2002-2009) for all thrombolytic-treated patients presenting with acute ischemic stroke with or without dialysis dependence. Patients were identified using the International Classification of Disease, Ninth Revision, Clinical Modification codes. Baseline characteristics, in-hospital complications including secondary intracerebral hemorrhage (ICH), sepsis, pneumonia, pulmonary embolism, deep venous thrombosis, urinary tract infections, and discharge outcomes (mortality, minimal disability, and moderate-to-severe disability) were compared between the groups.
Of the 82,142 patients with ischemic stroke who receive thrombolytic treatment, 1072 (1.3%) was dialysis dependent. The ICH rates did not differ significantly between patients with ischemic stroke with or without dialysis who received thrombolytics (5.2% versus 6.1%). The in-hospital mortality rate was higher in dialysis-dependent patients treated with thrombolytics (22% versus 11%, P≤.0001). After adjusting for age, sex, and comorbidities, dialysis dependence was associated with higher rates of in-hospital mortality in patients treated with thrombolytics (odds ratio, 1.92; 95% confidence interval, 1.33-2.78, P=.0005).
The 2-fold higher odds of in-hospital mortality associated with administration of IV thrombolytics in dialysis-dependent patients who present with acute ischemic stroke warrant a careful assessment of risk-benefit ratio in this population.
在美国，研究接受静脉（IV）溶栓治疗的伴有缺血性脑卒中的透析依赖型肾衰竭患者的治疗结局。
我们分析了全美住院患者样本（2002-2009 年）中所有接受急性缺血性脑卒中溶栓治疗的患者的数据，包括有或无透析依赖的患者。使用国际疾病分类，第九修订版，临床修正代码来识别患者。比较两组患者的基线特征、住院并发症（包括继发性脑出血（ICH）、脓毒症、肺炎、肺栓塞、深静脉血栓形成、尿路感染和出院结局（死亡率、轻度残疾和中度至重度残疾））。
在接受溶栓治疗的 82142 例缺血性脑卒中患者中，有 1072 例（1.3%）为透析依赖。接受溶栓治疗的伴有或不伴有透析依赖的缺血性脑卒中患者的 ICH 发生率无显著差异（5.2%与 6.1%）。接受溶栓治疗的透析依赖患者的住院死亡率较高（22%与 11%，P≤.0001）。在校正年龄、性别和合并症后，透析依赖与接受溶栓治疗的患者住院死亡率升高相关（比值比，1.92；95%置信区间，1.33-2.78，P=.0005）。
在伴有急性缺血性脑卒中的透析依赖患者中，接受 IV 溶栓治疗与住院期间死亡率增加 2 倍相关，这需要在该人群中仔细评估风险效益比。
