Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Eur J Neurol. 2022 Sep;29(9):2716-2724. doi: 10.1111/ene.15431. Epub 2022 Jun 17.
Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction.
The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD-EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m . eGFR dynamics were classified based on two in-hospital values as "stable normal" (≥60 ml/min/1.73 m ), "increasing" (by at least 15% from baseline, second value ≥ 60 ml/min/1.73 m ), "decreasing" (by at least 15% from baseline of ≥60 ml/min/1.73 m ), and "stable decreased" (<60 ml/min/1.73 m ). The composite endpoint (stroke, major bleeding, myocardial infarction, all-cause death) was assessed after 24 months. We estimated hazard ratios in confounder-adjusted models.
Estimated glomerular filtration rate at baseline was available in 2947 and a second value in 1623 patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, eGFR < 60 ml/min/1.73 m at baseline (hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.40-3.54) as well as decreasing (HR = 1.79, 95% CI = 1.07-2.99) and stable decreased eGFR (HR = 1.64, 95% CI = 1.20-2.24) were independently associated with the composite endpoint. In addition, eGFR < 60 ml/min/1.73 at baseline (HR = 3.02, 95% CI = 1.51-6.10) and decreasing eGFR were associated with all-cause death (HR = 3.12, 95% CI = 1.63-5.98).
In addition to patients with low eGFR levels at baseline, also those with decreasing eGFR have increased risk for vascular events and death; hence, repeated estimates of eGFR might add relevant information to risk prediction.
在评估急性脑卒中患者时，肾小球滤过率(eGFR)的单次测量结果显示，肾功能受损与血管事件风险增加相关。目前尚不清楚重复测量是否可以提供额外的风险预测信息。
MonDAFIS（急性缺血性脑卒中患者心房颤动的系统监测）研究将 3465 例急性缺血性脑卒中患者随机分为标准程序组或附加动态心电图监测 Holter 组。根据基线时（CKD-EPI 公式）的 eGFR（肾小球滤过率估计值）分为<60ml/min/1.73m2 和≥60ml/min/1.73m2。根据两次住院时的值，将 eGFR 动态分为“稳定正常”（≥60ml/min/1.73m2）、“升高”（至少比基线升高 15%，第二次值≥60ml/min/1.73m2）、“降低”（至少比基线的≥60ml/min/1.73m2降低 15%）和“稳定降低”（<60ml/min/1.73m2）。在 24 个月时评估复合终点（脑卒中、大出血、心肌梗死、全因死亡）。我们在混杂因素调整模型中估计了危险比。
在 2947 例患者中可获得基线时的 eGFR，在 1623 例患者中可获得第二次值。在调整年龄、脑卒中严重程度、心血管危险因素和随机分组后，基线时 eGFR<60ml/min/1.73m2（HR=2.2，95%CI=1.40-3.54）、降低（HR=1.79，95%CI=1.07-2.99）和稳定降低（HR=1.64，95%CI=1.20-2.24）与复合终点独立相关。此外，基线时 eGFR<60ml/min/1.73m2（HR=3.02，95%CI=1.51-6.10）和降低的 eGFR与全因死亡相关（HR=3.12，95%CI=1.63-5.98）。
除了基线时 eGFR 水平较低的患者外，eGFR 降低的患者也有更高的血管事件和死亡风险；因此，重复估计 eGFR 可能会为风险预测提供相关信息。
