急性肾衰竭与急性缺血性脑卒中患者的高死亡率和高残疾率相关：基于全国住院患者样本的分析。
Acute renal failure is associated with higher death and disability in patients with acute ischemic stroke: analysis of nationwide inpatient sample.
机构信息
From the Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH (F.S.); Zeenat Qureshi Stroke Institute, St. Cloud, MN (M.M.A., A.I.Q.); Department of Neurology, Louisiana State University Health Science Center, New Orleans, LA (F.K., L.A.B.); Department of Medicine, University of Rochester Medical Center, Rochester, NY (U.A.D.); and Department of Neurology, Ochsner Clinic Foundation, New Orleans, LA (G.A.V.).
出版信息
Stroke. 2014 May;45(5):1478-80. doi: 10.1161/STROKEAHA.114.004672. Epub 2014 Mar 11.
BACKGROUND AND PURPOSE
Acute renal failure (ARF) in setting of acute ischemic stroke (AIS) is associated with worse outcome. We sought to determine the prevalence of ARF and effect on outcomes of patients with AIS.
METHODS
Data from all patients admitted to US hospitals between 2002 and 2010 with a primary discharge diagnosis of ischemic stroke and secondary diagnosis of ARF were included. The effect of ARF on rates of intracerebral hemorrhage and discharge outcomes was analyzed after adjusting for potential confounders using logistic regression analysis.
RESULTS
Of 7,068,334 patients with AIS, 372,223 (5.3%) had ARF during hospitalization. Dialysis was required in 2364 (0.6%) of 372,223 patients. Patients with AIS with ARF had higher rates of moderate to severe disability (41.3% versus 30%; P<0.0001), intracerebral hemorrhage (1.0% versus 0.5%; P<0.0001), and in-hospital mortality (8.4% versus 2.9%; P<0.0001) compared with those without ARF. After adjusting for confounding factors, patients with AIS with ARF had higher odds of moderate to severe disability (odds ratio, 1.3; 95% confidence interval, 1.3-1.4; P<0.0001), intracerebral hemorrhage (odds ratio, 1.4; 95% confidence interval, 1.3-1.6; P<0.0001), and death (odds ratio, 2.2; 95% confidence interval, 2.0-2.2; P<0.0001).
CONCLUSIONS
ARF in patients with AIS is associated with significantly higher rates of moderate to severe disability at discharge and in-hospital mortality.
背景与目的
急性肾损伤（ARF）在急性缺血性脑卒中（AIS）患者中与更差的预后相关。我们旨在确定 AIS 患者中 ARF 的患病率及其对预后的影响。
方法
纳入 2002 年至 2010 年期间美国所有因急性缺血性脑卒中且二级诊断为 ARF 而住院的患者。使用 logistic 回归分析调整潜在混杂因素后，分析 ARF 对颅内出血和出院结局发生率的影响。
结果
在 7068334 例 AIS 患者中，372223 例（5.3%）在住院期间发生 ARF。在 372223 例患者中，2364 例（0.6%）需要透析。与无 ARF 的患者相比，患有 ARF 的 AIS 患者具有更高的中度至重度残疾率（41.3%与 30%；P<0.0001）、颅内出血发生率（1.0%与 0.5%；P<0.0001）和住院死亡率（8.4%与 2.9%；P<0.0001）。在调整混杂因素后，患有 ARF 的 AIS 患者发生中度至重度残疾的可能性更高（优势比，1.3；95%置信区间，1.3-1.4；P<0.0001）、颅内出血的可能性更高（优势比，1.4；95%置信区间，1.3-1.6；P<0.0001）和死亡的可能性更高（优势比，2.2；95%置信区间，2.0-2.2；P<0.0001）。
结论
AIS 患者发生 ARF 与出院时中重度残疾和住院死亡率显著升高相关。
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