Department of Nephrology, County Emergency Hospital Timisoara, Romania, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.
Department of Neurology, County Emergency Hospital Timisoara, Romania, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.
PLoS One. 2017 Oct 17;12(10):e0185589. doi: 10.1371/journal.pone.0185589. eCollection 2017.
Acute kidney injury (AKI) increases the risk of death in acute ischemic stroke (AIS) patients. Intravenous thrombolytic therapy (iv. rt-PA) seems to be the most effective treatment for AIS patients. The effects of AKI on iv. rt-PA treated AIS cases is less studied. Our paper addresses this issue.
45 consecutive stroke patients treated with iv. rt-PA (median age = 64 years; 29 male) and 59 age and sex matched controls not eligible for iv. rt-PA have been enrolled in our study. Subjects were followed-up until hospital release or death (median follow up time = 12 days).
The prevalence of AKI did not differ between iv. rt-PA treated patients and controls (35.5% vs. 33.89%). In both groups, AKI was associated with increased in-hospital mortality: 50.0% vs. 3.4% p<0.0001 (in the rt-PA treated), and 45% vs. 30.7% (in controls). AKI iv. rt-PA treated patients had a significantly higher risk of in hospital mortality as compared to the no-AKI iv. rt-PA treated (HR = 15.2 (95%CI [1.87 to 124.24]; P = 0.011). In a Cox-multivariate model, the presence of AKI after iv. rt-PA remained a significant factor (HR = 8.354; p = 0.041) influencing the in-hospital mortality even after correction for other confounding factors. The independent predictors for AKI were: decreased eGFR baseline and elevated serum levels of uric acid at admission, (the model explained 60.2% of the AKI development).
The risk of AKI was increased in AIS patients. Thrombolysis itself did not increase the risk of AKI. In the iv. rt-PA patients, as compared to non-AKI, those which developed AKI had a higher rate of in-hospital mortality. The baseline eGFR and the serum uric acid at admission were independent predictors for AKI development in the iv. rt-PA treated AIS patients.
急性肾损伤（AKI）会增加急性缺血性脑卒中（AIS）患者的死亡风险。静脉溶栓治疗（iv. rt-PA）似乎是治疗 AIS 患者最有效的方法。但 AKI 对接受 iv. rt-PA 治疗的 AIS 患者的影响研究较少。我们的研究旨在探讨这一问题。
本研究共纳入 45 例连续接受 iv. rt-PA 治疗的脑卒中患者（中位年龄=64 岁，29 例男性）和 59 例年龄和性别匹配但不符合 iv. rt-PA 治疗标准的对照组患者。所有患者均随访至出院或死亡（中位随访时间=12 天）。
iv. rt-PA 治疗组和对照组的 AKI 发生率无差异（35.5% vs. 33.89%）。在两组中，AKI 均与住院期间死亡率增加相关：50.0% vs. 3.4%，p<0.0001（iv. rt-PA 治疗组）和 45% vs. 30.7%（对照组）。与无 AKI 的 iv. rt-PA 治疗患者相比，AKI 患者的住院期间死亡率显著更高（HR=15.2（95%CI [1.87 至 124.24]；P=0.011）。在 Cox 多变量模型中，即使校正了其他混杂因素，iv. rt-PA 治疗后 AKI 的存在仍然是影响住院期间死亡率的显著因素（HR=8.354；p=0.041）。AKI 的独立预测因素为：基线 eGFR 降低和入院时血清尿酸水平升高（该模型解释了 AKI 发展的 60.2%）。
AIS 患者的 AKI 风险增加。溶栓本身不会增加 AKI 的风险。与非 AKI 患者相比，iv. rt-PA 治疗的 AKI 患者住院期间死亡率更高。基线 eGFR 和入院时血清尿酸是 iv. rt-PA 治疗的 AIS 患者发生 AKI 的独立预测因素。
