Lima Helbert do Nascimento, Saibel Tais, Colato Gisele, Cabral Norberto Luiz
Universidade da Região de Joinville, Departamento de Medicina, Joinville, SC, Brasil.
J Bras Nefrol. 2019 Jul-Sept;41(3):323-329. doi: 10.1590/2175-8239-JBN-2018-0215.
The occurrence of acute kidney injury (AKI) after ischemic stroke has been associated to a worse prognosis. There is a lack of Brazilian studies evaluating this issue. This study aimed to describe the impact of AKI after a first-ever ischemic stroke in relation to fatality rate in 30 days.
This was a retrospective hospital-based cohort. We included patients who had their first ischemic stroke between January to December 2015. AKI was defined by an increase of serum creatinine in relation to baseline value at admission ≥ 0.3 mg/dL or a rise in serum creatinine level by 1.5 times the baseline value at any point in the first week after admission. We performed a univariate and multivariate analysis to evaluate the presence of AKI with fatality in 30 days.
The final study population (n=214) had mean age of 66.46 ± 13.73 years, 48.1% were men, the mean NIHSS was 6.33 ± 6.27 and 20 (9.3%) presented AKI. Patients with AKI were older, had a higher score on the NIHSS, and had higher creatinine values on hospital discharge. The 30-day mortality was higher in the AKI subgroup compared to non-AKI (35% vs. 6.2%, p < 0.001). AKI was an independent predictor of fatality after an ischemic stroke but limited by severity of stroke (NIHSS).
The presence of AKI is an important complication after ischemic stroke. Despite its impact on 30-day fatality, the predictive strength of AKI was limited by the severity of stroke.
缺血性中风后发生急性肾损伤（AKI）与预后较差相关。巴西缺乏评估此问题的研究。本研究旨在描述首次缺血性中风后AKI对30天死亡率的影响。
这是一项基于医院的回顾性队列研究。我们纳入了2015年1月至12月首次发生缺血性中风的患者。AKI的定义为入院时血清肌酐相对于基线值升高≥0.3mg/dL，或入院后第一周内任何时间血清肌酐水平升高至基线值的1.5倍。我们进行了单因素和多因素分析，以评估AKI与30天死亡率之间的关系。
最终研究人群（n = 214）的平均年龄为66.46±13.73岁，男性占48.1%，美国国立卫生研究院卒中量表（NIHSS）平均评分为6.33±6.27，20例（9.3%）出现AKI。发生AKI的患者年龄更大，NIHSS评分更高，出院时肌酐值更高。与未发生AKI的患者相比，AKI亚组的30天死亡率更高（35%对6.2%，p < 0.001）。AKI是缺血性中风后死亡的独立预测因素，但受中风严重程度（NIHSS）的限制。
AKI的存在是缺血性中风后的重要并发症。尽管其对30天死亡率有影响，但AKI的预测强度受中风严重程度的限制。
