Liu Chengfang, Li Xiaohui, Xu Zhaohan, Wang Yishan, Jiang Teng, Wang Meng, Deng Qiwen, Zhou Junshan
Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
Department of Laboratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
J Clin Med. 2022 Jul 3;11(13):3865. doi: 10.3390/jcm11133865.
Background: Hyperglycaemia is thought to be connected to worse functional outcomes after ischaemic stroke. However, the association between hyperglycaemia and acute kidney injury (AKI) after endovascular treatment (EVT) remains elusive. The purpose of this study was to investigate the influence of glycaemic on AKI after EVT. Methods: We retrospectively collected the clinical information of patients who underwent EVT from April 2015 to August 2021. Blood glucose after EVT was recorded as acute glycaemia. Chronic glucose levels were estimated by glycosylated haemoglobin (HbA1c) using the following formula: chronic glucose levels (mg/dL) = 28.7 × HbA1c (%) − 46.7. AKI was defined as an increase in maximum serum creatinine to ≥1.5 baseline. We evaluated the association of AKI with blood glucose. A nomogram was established to predict the risk of AKI, and its diagnostic efficiency was determined by decision curve analysis. Results: We enrolled 717 acute ischaemic stroke patients who underwent EVT. Of them, 205 (28.6%) experienced AKI. Acute glycaemia (OR: 1.007, 95% CI: 1.003−1.011, p < 0.001), the acute/chronic glycaemic ratio (OR: 4.455, 95% CI: 2.237−8.871, p < 0.001) and the difference between acute and chronic glycaemia (ΔA-C) (OR: 1.008, 95% CI: 1.004−1.013, p < 0.001) were associated with the incidence of AKI. Additionally, age, atrial fibrillation, ASITN/SIR collateral grading, postoperative mTICI scale, and admission NIHSS were also significantly correlated with AKI. We then created a glycaemia-based nomogram, and its concordance index was 0.743. The net benefit of the nomogram was further confirmed by decision curve analysis. Conclusions: The glycaemia-based nomogram may be used to predict AKI in ischaemic stroke patients receiving EVT.
高血糖被认为与缺血性中风后较差的功能结局有关。然而，高血糖与血管内治疗（EVT）后急性肾损伤（AKI）之间的关联仍不明确。本研究的目的是探讨血糖对EVT后AKI的影响。方法：我们回顾性收集了2015年4月至2021年8月接受EVT治疗的患者的临床信息。将EVT后的血糖记录为急性血糖。使用以下公式通过糖化血红蛋白（HbA1c）估算慢性血糖水平：慢性血糖水平（mg/dL）=28.7×HbA1c（%）−46.7。AKI定义为最大血清肌酐升高至≥1.5倍基线水平。我们评估了AKI与血糖的关联。建立了一个列线图来预测AKI的风险，并通过决策曲线分析确定其诊断效率。结果：我们纳入了717例接受EVT治疗的急性缺血性中风患者。其中，205例（28.6%）发生了AKI。急性血糖（OR：1.007，95%CI：1.003−1.011，p<0.001）、急性/慢性血糖比值（OR：4.455，95%CI：2.237−8.871，p<0.001）以及急性与慢性血糖之差（ΔA-C）（OR：1.008，95%CI：1.004−1.013，p<0.001）与AKI的发生率相关。此外，年龄、心房颤动、ASITN/SIR侧支分级、术后mTICI量表和入院时NIHSS也与AKI显著相关。然后我们创建了一个基于血糖的列线图，其一致性指数为0.743。决策曲线分析进一步证实了列线图的净效益。结论：基于血糖的列线图可用于预测接受EVT治疗的缺血性中风患者发生AKI的风险。
