估计肾小球滤过率降低影响脑出血后3个月的预后：脑出血紧急危险因素评估与改善的急性卒中管理研究

Reduced estimated glomerular filtration rate affects outcomes 3 months after intracerebral hemorrhage: the stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study.

作者信息

Miyagi Tetsuya, Koga Masatoshi, Yamagami Hiroshi, Okuda Satoshi, Okada Yasushi, Kimura Kazumi, Shiokawa Yoshiaki, Nakagawara Jyoji, Furui Eisuke, Hasegawa Yasuhiro, Kario Kazuomi, Arihiro Shoji, Sato Shoichiro, Minematsu Kazuo, Toyoda Kazunori

机构信息

Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.

Department of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.

出版信息

J Stroke Cerebrovasc Dis. 2015 Jan;24(1):176-82. doi: 10.1016/j.jstrokecerebrovasdis.2014.08.015. Epub 2014 Nov 6.

DOI:10.1016/j.jstrokecerebrovasdis.2014.08.015

PMID:25440328

Abstract

BACKGROUND

The effect of renal dysfunction on intracerebral hemorrhage (ICH) remains unclear. We investigated associations of renal dysfunction assessed by estimated glomerular filtration rate (eGFR) with clinical courses and outcomes in ICH patients.

METHODS

From a prospective, multicenter, observational study, 203 patients who had supratentorial ICH within 3 hours of onset were included. Patients were classified into 3 groups based on eGFR: Group 1 (eGFR < 60 mL/minute/m(2)), Group 2 (60-89), and Group 3 (≥ 90). Outcomes included neurologic deterioration within 72 hours, hematoma expansion (> 33% in volume) at 24 hours, and favorable (modified Rankin Scale [mRS] ≤ 2) or unfavorable (mRS ≥ 5) outcome at 3 months.

RESULTS

Thirty-seven patients (16 women, 74.6 ± 13.2 years) were assigned to Group 1, 99 (34 women, 65.2 ± 11.4 years) to Group 2, and 67 (30 women, 61.3 ± 9.4 years) to Group 3. Significant differences were found in age (P < .001) and initial systolic blood pressure among the groups (208.4 ± 18.0, 201.9 ± 15.1, and 198.1 ± 14.2 mm Hg for Group 1, 2, and 3, respectively; P = .006). Similar rates of neurologic deterioration (14%, 6%, and 6%) and hematoma expansion (16%, 14%, and 18%) were observed among the groups. However, in Group 1, favorable outcome was less frequent (17%, 48%, and 42%; P = .002) and unfavorable outcome was more frequent (24%, 7%, and 6%; P = .013) than in the other groups. After adjustment for confounders, eGFR < 60 mL/minute/m(2) was independently associated with both favorable outcome (odds ratio [OR], .21; 95% CI, .07-.54) and unfavorable outcome (OR, 5.64; 95% CI, 1.80-18.58).

CONCLUSIONS

Renal dysfunction (eGFR < 60 mL/minute/m(2)) was associated with poor clinical outcome after ICH.

摘要

背景

肾功能不全对脑出血（ICH）的影响仍不清楚。我们研究了通过估计肾小球滤过率（eGFR）评估的肾功能不全与ICH患者临床病程及预后的相关性。

方法

在一项前瞻性、多中心、观察性研究中，纳入了203例发病3小时内幕上ICH患者。根据eGFR将患者分为3组：第1组（eGFR<60ml/分钟/平方米），第2组（60 - 89），第3组（≥90）。结局包括72小时内神经功能恶化、24小时血肿扩大（体积增加>33%）以及3个月时良好（改良Rankin量表[mRS]≤2）或不良（mRS≥5）结局。

结果

第1组有37例患者（女性16例，年龄74.6±13.2岁），第2组99例（女性34例，年龄65.2±11.4岁），第3组67例（女性30例，年龄61.3±9.4岁）。各组在年龄（P<.001）和初始收缩压方面存在显著差异（第1、2、3组分别为208.4±18.0、201.9±15.1和198.1±14.2mmHg；P =.006）。各组神经功能恶化率（14%、6%和6%）和血肿扩大率（16%、14%和18%）相似。然而，与其他组相比，第1组良好结局的发生率较低（17%、48%和42%；P =.002），不良结局的发生率较高（24%、7%和6%；P =.013）。在对混杂因素进行调整后，eGFR<60ml/分钟/平方米与良好结局（优势比[OR]，.21；95%CI，.07 -.54）和不良结局（OR，5.64；95%CI，1.80 - 18.58）均独立相关。