Wang Dongxue, Pan Yuesong, Li Hao, Yan Hongyi, Meng Xia, Lin Jinxi, Wang Hong, Matsushita Kunihiro, Shlipak Michael G, Zhou Yilun, Wang Yongjun
Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Cerebrovasc Dis. 2022;51(1):67-74. doi: 10.1159/000518180. Epub 2021 Aug 25.
The association between the changes in albuminuria levels and the clinical prognosis of stroke is unknown. The present study aimed to explore the relationships between changes in albuminuria and the risk of adverse stroke outcomes.
The patients with ischemic stroke or transient ischemic attack from the Third China National Stroke Registry (CNSR-III) who had the urinary albumin-to-creatinine ratio (ACR) detected at baseline and 3-month were recruited. They were classified into 4 groups according to baseline and 3-month ACR and followed up for 1 year.
A total of 5,311 patients were finally included in the study. There were 3,738 (70.4%), 483 (9.1%), 451 (8.5%), and 639 (12.0%) patients with no albuminuria, baseline albuminuria, 3-month albuminuria, and persistent albuminuria, respectively. After adjustment for confounding variables, persistent albuminuria was independently associated with all-cause death (hazard ratio [HR], 2.23; 95% CI, 1.17-4.25; p = 0.02), stroke recurrence (HR, 1.55; 95% CI, 1.02-2.36; p = 0.04), and poor functional outcome (OR, 2.22; 95% CI, 1.66-2.96; p < 0.001). Baseline albuminuria was independently associated with poor functional outcome (OR, 1.65; 95% CI, 1.19-2.28; p = 0.003), while 3-month albuminuria was independently associated with stroke recurrence (HR, 1.68; 95% CI, 1.06-2.65; p = 0.03).
Changes in albuminuria can predict adverse 1-year outcomes in Chinese ischemic stroke patients. In particular, persistent albuminuria was independently associated with 1-year all-cause death, stroke recurrence, and poor functional outcome.
蛋白尿水平变化与中风临床预后之间的关联尚不清楚。本研究旨在探讨蛋白尿变化与中风不良结局风险之间的关系。
招募来自中国国家卒中登记研究三期（CNSR-III）的缺血性中风或短暂性脑缺血发作患者，这些患者在基线期和3个月时检测了尿白蛋白与肌酐比值（ACR）。根据基线期和3个月时的ACR将他们分为4组，并随访1年。
本研究最终共纳入5311例患者。无蛋白尿、基线蛋白尿、3个月蛋白尿和持续性蛋白尿的患者分别有3738例（70.4%）、483例（9.1%）、451例（8.5%）和639例（12.0%）。在对混杂变量进行校正后，持续性蛋白尿与全因死亡（风险比[HR]，2.23；95%置信区间[CI]，1.17 - 4.25；p = 0.02）、中风复发（HR，1.55；95%CI，1.02 - 2.36；p = 0.04）和功能结局不良（比值比[OR]，2.22；95%CI，1.66 - 2.96；p < 0.001）独立相关。基线蛋白尿与功能结局不良独立相关（OR，1.65；95%CI，1.19 - 2.28；p = 0.003），而3个月蛋白尿与中风复发独立相关（HR，1.68；95%CI，1.06 - 2.65；p = 0.03）。
蛋白尿变化可预测中国缺血性中风患者1年的不良结局。特别是，持续性蛋白尿与1年全因死亡、中风复发和功能结局不良独立相关。
