肾功能障碍与卒中后出院处置及住院死亡率相关：来自“遵循指南-卒中”项目的研究结果
Renal Dysfunction Is Associated With Poststroke Discharge Disposition and In-Hospital Mortality: Findings From Get With The Guidelines-Stroke.
作者信息
El Husseini Nada, Fonarow Gregg C, Smith Eric E, Ju Christine, Schwamm Lee H, Hernandez Adrian F, Schulte Phillip J, Xian Ying, Goldstein Larry B
机构信息
From the Department of Neurology, Wake Forest Baptist University Health Sciences, Winston-Salem, NC (N.E.H.); Duke Clinical Research Institute (C.J., A.F.H., P.J.S., Y.X.) and Department of Neurology (N.E.H., Y.X.), Duke University Medical Center, Durham, NC; UCLA Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); Massachusetts General Hospital, Boston (L.H.S.); and Department of Neurology, University of Kentucky, Lexington (L.B.G.).
出版信息
Stroke. 2017 Feb;48(2):327-334. doi: 10.1161/STROKEAHA.116.014601. Epub 2016 Dec 29.
BACKGROUND AND PURPOSE
Kidney disease is a frequent comorbidity in patients presenting with acute ischemic stroke. We evaluated whether the estimated glomerular filtration rate (eGFR) on admission is associated with poststroke in-hospital mortality or discharge disposition.
METHODS
In this cohort study, data from ischemic stroke patients in Get With The Guidelines-Stroke linked to fee-for-service Medicare data were analyzed. The Modification of Diet in Renal Disease study equation was used to calculate the eGFR (mL/min/1.73 m). Dialysis was identified by International Classification of Diseases, Ninth Revision codes. Adjusted multivariable Cox proportional hazards models were used to determine the independent associations of eGFR with discharge disposition and in-hospital mortality. Adjusted individual models also examined whether the association of clinical and demographic factors with outcomes varied by eGFR level.
RESULTS
Of 232 236 patients, 47.3% had an eGFR ≥60, 26.6% an eGFR 45 to 59, 16.8% an eGFR 30 to 44, 5.6% an eGFR 15 to 29, 0.7% an eGFR<15 without dialysis, and 2.8% were receiving dialysis. Of the total cohort, 11.8% died during the hospitalization or were discharged to hospice, and 38.6% were discharged home. After adjusting for other relevant variables, renal dysfunction was independently associated with an increased risk of in-hospital mortality that was highest among those with eGFR <15 without dialysis (odds ratio, 2.52; 95% confidence interval, 2.07-3.07). An eGFR 15 to 29 (odds ratio, 0.82; 95% confidence interval, 0.78-0.87), eGFR <15 (odds ratio, 0.72; 95% confidence interval, 0.61-0.86), and dialysis (odds ratio, 0.86; 95% confidence interval, 0.79-0.94) remained associated with lower odds of being discharged home. In addition, the associations of several clinical and demographic factors with outcomes varied by eGFR level.
CONCLUSIONS
eGFR on admission is an important predictor of poststroke short-term outcomes.
背景与目的
肾病是急性缺血性卒中患者常见的合并症。我们评估了入院时的估计肾小球滤过率（eGFR）是否与卒中后住院死亡率或出院转归相关。
方法
在这项队列研究中，分析了来自“遵循卒中指南”（Get With The Guidelines-Stroke）项目中缺血性卒中患者的数据，并与按服务付费的医疗保险数据相链接。采用肾脏病饮食改良（Modification of Diet in Renal Disease）研究公式计算eGFR（毫升/分钟/1.73平方米）。通过国际疾病分类第九版编码确定透析情况。使用校正后的多变量Cox比例风险模型来确定eGFR与出院转归和住院死亡率之间的独立关联。校正后的个体模型还检验了临床和人口统计学因素与结局之间的关联是否因eGFR水平而异。
结果
在232236例患者中，47.3%的患者eGFR≥60，26.6%的患者eGFR为45至59，16.8%的患者eGFR为30至44，5.6%的患者eGFR为15至29，0.7%的患者eGFR<15且未接受透析，2.8%的患者正在接受透析。在整个队列中，11.8%的患者在住院期间死亡或出院至临终关怀机构，38.6%的患者出院回家。在调整其他相关变量后，肾功能不全与住院死亡率增加独立相关，在eGFR<15且未接受透析的患者中风险最高（比值比，2.52；95%置信区间，2.07 - 3.07）。eGFR为15至29（比值比，0.82；95%置信区间，0.78 - 0.87）、eGFR<15（比值比，0.72；95%置信区间，0.61 - 0.86）以及透析（比值比，0.86；95%置信区间，0.79 - 0.94）与出院回家的较低几率仍相关。此外，几种临床和人口统计学因素与结局之间的关联因eGFR水平而异。
结论
入院时的eGFR是卒中后短期结局的重要预测指标。
Zotero 插件