Liu Huihui, Zheng Huaguang, Wu Peng, Liu Chun-Feng, Wang David, Li Hao, Meng Xia, Wang Yongjun, Cao Yongjun, Wang Yilong, Pan Yuesong
Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Ann Transl Med. 2020 Jan;8(1):2. doi: 10.21037/atm.2019.11.148.
Anemia is highly prevalent in patients with low estimated glomerular filtration rate (eGFR). However, the combined effect of anemia and low eGFR on the prognosis of stroke has not been well studied.
Data of patients with acute ischemic stroke in the prospective cohort study of China National Stroke Registry was reviewed. According to the levels of eGFR and hemoglobin, patients were categorized into four groups: low eGFR (<60 mL/min per 1.73 m) or normal eGFR (≥60 mL/min per 1.73 m) with or without anemia. Multivariate logistic regression methods were used to analyze the association between eGFR with or without anemia and outcomes after stroke [the poor functional outcome (modified Rankin Scale, mRS 3-6), mortality and stroke recurrence] at 3 months and 1 year.
This study included 8,303 stroke patients. After adjusting for the confounding factors, low eGFR with normal hemoglobin increased the risk of mortality at 1 year of follow-up [odds ratio (OR) =1.50; 95% confidence interval (95% CI), 1.14-1.97]. Anemia with normal eGFR was not associated with any poor outcome at 1-year of follow-up. In patients with both low eGFR and anemia, there was an increased risk of 1-year poor functional outcome (OR 1.73; 95% CI, 1.30-2.29), mortality (OR 2.64; 95% CI, 1.94-3.59) and stroke recurrence (OR 1.42; 95% CI, 1.06-1.91). Combined and interactive effects of the pattern of low eGFR and anemia on the poor functional outcome (P for interaction =0.02) and all-cause mortality (P for interaction =0.046) were observed.
Ischemic stroke patients with concurrent low eGFR and anemia increased risks of poor functional outcome, mortality and stroke recurrence after 1-year follow-up.
贫血在估算肾小球滤过率（eGFR）较低的患者中极为普遍。然而，贫血与低eGFR对中风预后的综合影响尚未得到充分研究。
回顾了中国国家中风登记处前瞻性队列研究中急性缺血性中风患者的数据。根据eGFR和血红蛋白水平，患者被分为四组：伴有或不伴有贫血的低eGFR（<60 ml/min per 1.73 m²）或正常eGFR（≥60 ml/min per 1.73 m²）。采用多变量逻辑回归方法分析伴有或不伴有贫血的eGFR与中风后3个月和1年的结局[不良功能结局（改良Rankin量表，mRS 3 - 6）、死亡率和中风复发]之间的关联。
本研究纳入了8303例中风患者。在调整混杂因素后，血红蛋白正常的低eGFR增加了随访1年时的死亡风险[比值比（OR）=1.50；95%置信区间（95%CI），1.14 - 1.97]。eGFR正常的贫血在随访1年时与任何不良结局均无关联。在同时患有低eGFR和贫血的患者中，1年不良功能结局（OR 1.73；95%CI，1.30 - 2.29）、死亡率（OR 2.64；95%CI，1.94 - 3.59）和中风复发（OR 1.42；95%CI，1.06 - 1.91）的风险增加。观察到低eGFR和贫血模式对不良功能结局（交互作用P = 0.02）和全因死亡率（交互作用P = 0.046）的联合和交互作用。
同时患有低eGFR和贫血的缺血性中风患者在随访1年后出现不良功能结局、死亡率和中风复发的风险增加。
