Kim Hyung Jik, Kim Jwa-Kyung, Oh Mi Sun, Kim Sung Gyun, Yu Kyung-Ho, Lee Byung-Chul
Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
J Clin Neurol. 2015 Jan;11(1):73-9. doi: 10.3988/jcn.2015.11.1.73. Epub 2015 Jan 2.
Chronic kidney disease (CKD) is an established risk factor for numerous cardiovascular diseases including stroke. The relationship between the baseline estimated glomerular filtration rate (eGFR) and clinical 3-month outcomes in patients with acute ischemic stroke were evaluated in this study.
This was a prospective cohort study involving a hospital-based stroke registry; 1373 patients with acute ischemic stroke were enrolled. Patients were divided into the following four groups according their eGFR (calculated using the CKD Epidemiology Collaboration equations): ≥60, 45-59, 30-44, and <30 mL/min/1.73 m(2). The primary endpoint of poor functional outcome was defined as 3-month death or dependency (modified Rankin Scale score ≥3); secondary endpoints were neurological deterioration (increase in National Institutes of Health Stroke Severity score of ≥4 at discharge compared to baseline) during hospitalization and in-hospital mortality.
The overall eGFR was 84.5±20.8 mL/min/1.73 m(2) (mean±SD). The distribution of baseline renal impairment was as follows: 1,218, 82, 40, and 33 patients had eGFRs of ≥60, 45-59, 30-44, and <30 mL/min/1.73 m(2), respectively. At 3 months after the stroke, 476 (34.7%) patients exhibited poor functional outcome. Furthermore, a poor functional outcome occurred more frequently with increasingly advanced stages of CKD (rates of 31.9%, 53.7%, 55.0%, and 63.6% for CKD stages 1/2, 3a, 3b, and 4/5, respectively; p<0.001). Multivariate analysis revealed that a baseline eGFR of <30 mL/min/1.73m(2) increased the risk of a poor functional outcome by 2.37-fold (p=0.047). In addition, baseline renal dysfunction was closely associated with neurological deterioration during hospitalization and with in-hospital mortality.
A low baseline eGFR was strongly predictive of both poor functional outcome at 3 months after ischemic stroke and neurological deterioration/mortality during hospitalization.
慢性肾脏病（CKD）是包括中风在内的多种心血管疾病的既定危险因素。本研究评估了急性缺血性中风患者的基线估计肾小球滤过率（eGFR）与临床3个月结局之间的关系。
这是一项基于医院中风登记处的前瞻性队列研究；纳入了1373例急性缺血性中风患者。根据患者的eGFR（使用CKD流行病学协作组方程计算）将其分为以下四组：≥60、45 - 59、30 - 44和<30 mL/（min/1.73 m²）。功能结局不良的主要终点定义为3个月时死亡或依赖（改良Rankin量表评分≥3）；次要终点为住院期间神经功能恶化（出院时美国国立卫生研究院卒中严重程度评分较基线增加≥4）和院内死亡率。
总体eGFR为84.5±20.8 mL/（min/1.73 m²）（均值±标准差）。基线肾功能损害的分布如下：eGFR≥60、45 - 59、30 - 44和<30 mL/（min/1.73 m²）的患者分别有1218例、82例、40例和3例。中风后3个月时，476例（34.7%）患者出现功能结局不良。此外，随着CKD分期的进展，功能结局不良的发生频率更高（CKD 1/2、3a、3b和4/5期的发生率分别为31.9%、53.7%、55.0%和63.6%；p<0.001）。多变量分析显示，基线eGFR<30 mL/（min/1.73m²）使功能结局不良的风险增加2.37倍（p = 0.047）。此外，基线肾功能不全与住院期间神经功能恶化和院内死亡率密切相关。
低基线eGFR强烈预示缺血性中风后3个月功能结局不良以及住院期间神经功能恶化/死亡。
