Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
Eur J Neurol. 2018 Aug;25(8):1041-1048. doi: 10.1111/ene.13617. Epub 2018 Apr 6.
Chronic kidney disease and atrial fibrillation (AF) are two commonly coexisting risk factors of stroke. The aim of this study was to compare the association between impaired renal function and poor prognosis in ischaemic stroke patients with versus without AF.
Patients with ischaemic stroke in the China National Stroke Registry were included. Low estimated glomerular filtration rate (eGFR) on admission was defined as <60 ml/min/1.73 m . Outcomes included stroke recurrence, death, poor outcome defined as 3-6 on the modified Rankin Scale (mRS) and ordinal mRS at 12 months.
Of 9154 patients included, 1143 (12.5%) patients had a low eGFR. Patients with a low eGFR had more presence of AF compared with those with an eGFR of ≥90 ml/min/1.73 m [21.5% vs. 6.9%; odds ratio (OR) 1.77, 95% confidence interval (CI) 1.43-2.20]. An interaction of eGFR category by AF was observed for poor outcome and ordinal mRS (P for interaction = 0.04 and 0.002). In patients with AF, the OR with 95% CI of low eGFR was 1.86 (1.19-2.92) for stroke recurrence, 2.87 (1.82-4.52) for death, 1.83 (1.09-3.05) for poor outcome and 2.20 (1.52-3.18) for ordinal mRS. In patients without AF, low eGFR was only associated with death and ordinal mRS (OR 1.61, 95% CI 1.28-2.02; common OR 1.20, 95% CI 1.04-1.38; respectively).
Stroke patients with lower eGFR had more presence of AF. The associations of low eGFR with risk of poor prognosis in stroke patients with AF were stronger than those without AF.
慢性肾脏病和心房颤动（AF）是中风的两个常见共存危险因素。本研究旨在比较伴有和不伴有 AF 的缺血性中风患者肾功能受损与预后不良之间的关联。
纳入中国国家中风登记处的缺血性中风患者。入院时低估计肾小球滤过率（eGFR）定义为<60 ml/min/1.73 m 。结局包括中风复发、死亡、改良 Rankin 量表（mRS）定义的不良结局（3-6 分）和 12 个月时的 mRS 等级。
在 9154 例患者中，1143 例（12.5%）患者 eGFR 较低。与 eGFR≥90 ml/min/1.73 m 的患者相比，eGFR 较低的患者更易出现 AF [21.5% vs. 6.9%；比值比（OR）1.77，95%置信区间（CI）1.43-2.20]。eGFR 类别与 AF 之间存在交互作用，与不良结局和 mRS 等级有关（交互作用 P 值分别为 0.04 和 0.002）。在伴有 AF 的患者中，低 eGFR 的 OR（95%CI）分别为中风复发 1.86（1.19-2.92）、死亡 2.87（1.82-4.52）、不良结局 1.83（1.09-3.05）和 mRS 等级 2.20（1.52-3.18）。在不伴有 AF 的患者中，低 eGFR 仅与死亡和 mRS 等级有关（OR 1.61，95%CI 1.28-2.02；常见 OR 1.20，95%CI 1.04-1.38）。
eGFR 较低的中风患者更易出现 AF。伴有 AF 的中风患者 eGFR 较低与预后不良的相关性强于不伴有 AF 的患者。
