Dept. of Neurology, University Clinical Centre Maribor , Maribor , Slovenia .
Ren Fail. 2014 Feb;36(1):81-6. doi: 10.3109/0886022X.2013.832314. Epub 2013 Sep 13.
Renal dysfunction is associated with mortality in patients after ischemic stroke. Cystatin C is a potentially superior marker of renal function compared to creatinine and estimated glomerular filtration rate (GFR). In our observational cohort study, 390 Caucasian patients suffered from acute ischemic stroke (mean age 70.9 years; 183 women and 207 men) were included and prospectively followed up to maximal 56 months. Serum creatinine and cystatin C were measured at admission to the hospital; GFR was estimated according to CKD-EPI creatinine and CKD-EPI creatinine/cystatin equations. According to values of serum creatinine, estimated GFR and serum cystatin C patients were divided into quintiles. In the follow-up period, 191 (49%) patients died. For serum cystatin C and estimated GFR based on creatinine and cystatin C, the mortality and the hazard ratios for long-term mortality increased from the first to the fifth quintile nearly linearly. The associations of serum creatinine and estimated GFR categories based on creatinine with long-term mortality were J-shaped. As compared with lowest quintile of serum cystatin C, the fifth quintile was associated with long-term mortality significantly also after multivariate adjustment (age, gender, initial stroke severity, known risk factors for stroke mortality). In contrast, in adjusted analysis serum creatinine and estimated GFR (CKD-EPI creatinine and CKD-EPI creatinine/cystatin) were not associated with long-term mortality. In summary, serum cystatin C was independently and better associated with the risk of long-term mortality in patients suffering from ischemic stroke than were creatinine and estimated GFR using both CKD-EPI equations.
肾功能障碍与缺血性中风后患者的死亡率有关。与肌酐和估算肾小球滤过率（GFR）相比，胱抑素 C 是肾功能的潜在更优标志物。在我们的观察性队列研究中，纳入了 390 名白种人急性缺血性中风患者（平均年龄 70.9 岁；183 名女性和 207 名男性），并前瞻性随访至最长 56 个月。入院时测量血清肌酐和胱抑素 C；根据 CKD-EPI 肌酐和 CKD-EPI 肌酐/胱抑素方程估算 GFR。根据血清肌酐、估算 GFR 和血清胱抑素 C 的值，患者被分为五组。在随访期间，191 名（49%）患者死亡。对于基于肌酐和胱抑素 C 的血清胱抑素 C 和估算 GFR，死亡率和长期死亡率的风险比几乎呈线性从第一组到第五组增加。基于肌酐的血清肌酐和估算 GFR 类别与长期死亡率的关系呈 J 形。与最低五分位组的血清胱抑素 C 相比，即使在进行多变量调整（年龄、性别、初始中风严重程度、中风死亡率的已知危险因素）后，第五五分位组也与长期死亡率显著相关。相比之下，在调整分析中，血清肌酐和估算 GFR（CKD-EPI 肌酐和 CKD-EPI 肌酐/胱抑素）与长期死亡率无关。总之，与使用两种 CKD-EPI 方程的肌酐和估算 GFR 相比，血清胱抑素 C 与缺血性中风患者的长期死亡率风险独立且更好相关。
