Department of Clinical Medicine, Health Science Center and Radiology Service of the University Hospital, State University of Londrina, Paraná, Brazil.
Department of Pharmaceutical Sciences, Health Sciences Center, State University of Londrina, Paraná, Brazil.
Clin Neurol Neurosurg. 2024 Oct;245:108470. doi: 10.1016/j.clineuro.2024.108470. Epub 2024 Jul 26.
The mechanisms that modulate the onset of acute kidney inlury (AKI) after ischemic stroke (IS) and valuable biomarkers to predict the occurrence and prognosis of AKI among patients with IS are missing.
To evaluate the frequency of AKI and the prognostic validity of clinical and laboratory biomarkers in predicting AKI and short-term mortality after the IS.
Ninety-five patients with IS were enrolled. Baseline IS severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and disability was determined after three-month follow-up using the modified Rankin Scale. Patients with IS were also categorized as survivors and non-survivors after the follow-up. Baseline data and laboratory biomarkers were obtained up to 24 h of the admission.
Fifteen (15.7 %) patients with IS presented AKI. The proportion of patients with vitamin D deficiency and the mortality were higher among those with AKI than those without AKI (p=0.011 and p-0.009, respectively). Patients with AKI showed higher disability and higher increased soluble vascular cellular adhesion molecule-1 (sVCAM-1) than those without AKI (p=0.029 and p=0.023, respectively). Logistic regression analysis showed that only sVCAM-1 was associated with the occurrence of AKI after IS [odds ratio (OR): 2.715, 95 % confidence intereval (CI): 1.12-6.67, p=0.027]. When both AKI and NIHSS were evaluated as explanatory variables, this panel showed an OR of 5.782 (95 % CI: 1.09-30.43, p<0.001) and correctly classified 83.6 % of cases.
In conclusion, sVCAM-1 levels showed a potential useful for prediction of AKI after IS.
调节缺血性脑卒中(IS)后急性肾损伤(AKI)发生的机制以及预测 IS 患者 AKI 发生和预后的有价值的生物标志物尚不清楚。
评估 AKI 的频率以及临床和实验室生物标志物在预测 IS 后 AKI 和短期死亡率方面的预后准确性。
共纳入 95 例 IS 患者。采用美国国立卫生研究院卒中量表(NIHSS)评估基线 IS 严重程度,采用改良 Rankin 量表在 3 个月随访时评估残疾程度。IS 患者在随访后也分为存活者和非存活者。在入院后 24 小时内获得基线数据和实验室生物标志物。
15 例(15.7%)IS 患者出现 AKI。AKI 患者维生素 D 缺乏的比例和死亡率均高于无 AKI 患者(p=0.011 和 p-0.009)。AKI 患者的残疾程度和可溶性血管细胞黏附分子-1(sVCAM-1)水平均高于无 AKI 患者(p=0.029 和 p=0.023)。Logistic 回归分析显示,只有 sVCAM-1 与 IS 后 AKI 的发生相关[比值比(OR):2.715,95%置信区间(CI):1.12-6.67,p=0.027]。当 AKI 和 NIHSS 均被评估为解释变量时,该模型的 OR 为 5.782(95%CI:1.09-30.43,p<0.001),正确分类了 83.6%的病例。
总之,sVCAM-1 水平对预测 IS 后 AKI 有一定的应用价值。