慢性肾脏病与脑出血患者的临床结局。

Chronic Kidney Disease and Clinical Outcomes in Patients with Intracerebral Hemorrhage.

机构信息

Department of Neurology, University Hospital Erlangen, Erlangen, Germany.

出版信息

J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104802. doi: 10.1016/j.jstrokecerebrovasdis.2020.104802. Epub 2020 Apr 25.

DOI:10.1016/j.jstrokecerebrovasdis.2020.104802

PMID:32689604

Abstract

BACKGROUND AND PURPOSE

The influence of chronic kidney disease (CKD) on functional outcome in intracerebral hemorrhage (ICH) is scarcely investigated and reported findings are conflicting mostly because of nonaccounting for imbalances. Aim of the present study was to determine the impact of CKD on functional long-term outcome in ICH-patients.

METHODS

In this observational cohort study of spontaneous ICH-patients admitted to our Department of Neurology between 2006 and 2015 we investigated retrospectively as primary outcome the dichotomized functional status (modified-Rankin-Scale = 0-3-versus-4-6) at 12 months according to renal function (CKD versus non-CKD), including categorial estimates of the glomerular filtration rate subanalyses. Confounding was addressed by propensity-score(ps)-matching and adjusted multivariable regression analyses.

RESULTS

We identified 1076 eligible ICH-patients, of which 131 (12.2%) suffered from CKD on hospital admission. Confounders associated with CKD consisted of hypertension (P = .023), Diabetes mellitus (P = .001), prior ischemic stroke and/or transitory ischemic attack (TIA) (P = .021), congestive heart failure (P < .01), impaired liver function (P < .01), antiplatelet therapy (P = .01), poorer premorbid functional status (P < .01), and deep ICH-location (P = .006). After balancing for confounding, patients with CKD showed a significantly decreased rate of favorable functional outcome at 12 months (CKD:29 of 111(26.1%)-versus-non-CKD:78 of 206 (37.9%); P = .035). Subanalyses showed that stages of CKD were evenly associated with mortality at 12 months (GFR category G3a, OR:2.811; CI (1.130-6.994); P = .026; GFR category G3b, OR:1.874; CI (.694-5.058); P = .215; GFR category G4, OR:10.316; CI (1.976-53.856); P = .006; GFR category G5, OR:8.989; CI (1.900-42.518); P = .006).

CONCLUSIONS

As compared to ICH-patients without CKD, those with CKD show increased rates of mortality and worse functional outcomes even after statistical correction for imbalanced baseline characteritsics. This finding is presumably linked to comorbidity and warrants further investigation in prospective studies.

摘要

背景与目的

慢性肾脏病（CKD）对脑出血（ICH）患者功能预后的影响鲜有研究报道，且既往研究结果存在争议，这主要是因为既往研究并未考虑到组间的不平衡。本研究旨在确定 CKD 对 ICH 患者长期功能预后的影响。

方法

本研究为一项观察性队列研究，纳入 2006 年至 2015 年期间我院神经内科收治的自发性 ICH 患者，主要研究结局为根据肾功能（CKD 与非 CKD）将 12 个月时的功能状态（改良 Rankin 量表评分=0-3 分与 4-6 分）进行二分类，同时进行肾小球滤过率亚组的分类估计。采用倾向评分（ps）匹配和调整后的多变量回归分析来校正混杂因素。

结果

共纳入 1076 例 ICH 患者，其中 131 例（12.2%）入院时患有 CKD。与 CKD 相关的混杂因素包括高血压（P=0.023）、糖尿病（P=0.001）、既往缺血性卒中和/或短暂性脑缺血发作（TIA）（P=0.021）、充血性心力衰竭（P＜0.01）、肝功能受损（P＜0.01）、抗血小板治疗（P=0.01）、较差的预存功能状态（P＜0.01）和脑内血肿深部位置（P=0.006）。校正混杂因素后，CKD 患者 12 个月时的功能结局良好率显著降低（CKD：111 例中 29 例[26.1%]；非 CKD：206 例中 78 例[37.9%]；P=0.035）。亚组分析显示，CKD 各分期与 12 个月时的死亡率均呈正相关（GFR 类别 G3a，OR：2.811；95%CI：1.130-6.994；P=0.026；GFR 类别 G3b，OR：1.874；95%CI：0.694-5.058；P=0.215；GFR 类别 G4，OR：10.316；95%CI：1.976-53.856；P=0.006；GFR 类别 G5，OR：8.989；95%CI：1.900-42.518；P=0.006）。