Reddy Y Deekshitha, Thyagaraj Vijayashree, Shetty Viraj, Djeagou Albine, Tahir Sophia, Gill Satkarjeet Kaur, Khan Muhammad Usman, Ahmad Aftab, Patel Henna
General Medicine, MS Ramaiah Medical College, Bengaluru, IND.
Internal Medicine, MS Ramaiah Medical College, Bengaluru, IND.
Cureus. 2024 Nov 6;16(11):e73176. doi: 10.7759/cureus.73176. eCollection 2024 Nov.
Stroke is a leading cause of global morbidity and mortality, and understanding modifiable predictors of stroke outcomes is crucial. This study explores the relationship between renal function, assessed via estimated glomerular filtration rate (eGFR) and serum creatinine, and stroke mortality and functional outcomes in a cohort of acute stroke patients in India.
A prospective observational study was conducted from February 2021 to October 2022, including 104 acute stroke patients from MS Ramaiah Medical College and Hospital, Bengaluru, India. Patients were categorized into ischemic and hemorrhagic stroke groups. Data collected included demographic information, clinical history, and laboratory results. Functional outcomes were measured using the Modified Rankin Scale (mRS) at admission, day 7, and discharge. Renal function was evaluated using serum creatinine and eGFR. Statistical analyses, including multiple logistic regression, were performed to identify predictors of mortality.
The mean age of participants was 62.2 years, with a male predominance of 75 (72.1%). Hemorrhagic stroke patients had higher mortality rates compared to ischemic stroke patients (p = 0.006). Elevated serum creatinine and decreased eGFR were significantly associated with poorer outcomes. The eGFR at admission was lower in hemorrhagic stroke patients (55.6 ± 34.2 mL/min) compared to ischemic stroke patients (67.3 ± 29.6 mL/min; p = 0.048). Multiple logistic regression revealed that hemorrhagic stroke (OR = 0.17; 95% CI: 0.06 - 0.50) and age (OR = 1.06; 95% CI) were independent predictors of mortality. The threshold values for predicting mortality risk were 1.495 mg/dL for serum creatinine (sensitivity: 69.6%, specificity: 81.8%) and 48.5 mL/min for eGFR (sensitivity: 86.4%, specificity: 69.5%). These thresholds exhibited strong performance in assessing mortality risk, with AUCs (Area Under the Curve) of 0.765 for serum creatinine and 0.786 for eGFR.
Renal function indicators, specifically serum creatinine, and eGFR, are significant predictors of mortality and functional outcomes in acute stroke patients. Hemorrhagic stroke is associated with higher mortality and poorer renal function compared to ischemic stroke. These findings highlight the importance of assessing renal function in stroke management and suggest further research with larger cohorts to refine predictive models for stroke outcomes.
中风是全球发病和死亡的主要原因，了解中风预后的可改变预测因素至关重要。本研究探讨了通过估计肾小球滤过率（eGFR）和血清肌酐评估的肾功能与印度一组急性中风患者的中风死亡率及功能预后之间的关系。
于2021年2月至2022年10月进行了一项前瞻性观察性研究，纳入了印度班加罗尔MS拉马亚医学院和医院的104例急性中风患者。患者被分为缺血性和出血性中风组。收集的数据包括人口统计学信息、临床病史和实验室检查结果。在入院时、第7天和出院时使用改良Rankin量表（mRS）测量功能预后。使用血清肌酐和eGFR评估肾功能。进行了包括多元逻辑回归在内的统计分析，以确定死亡率的预测因素。
参与者的平均年龄为62.2岁，男性占主导，共75例（72.1%）。与缺血性中风患者相比，出血性中风患者的死亡率更高（p = 0.006）。血清肌酐升高和eGFR降低与较差的预后显著相关。出血性中风患者入院时的eGFR（55.6±34.2 mL/min）低于缺血性中风患者（67.3±29.6 mL/min；p = 0.048）。多元逻辑回归显示，出血性中风（OR = 0.17；95% CI：0.06 - 0.50）和年龄（OR = 1.06；95% CI）是死亡率的独立预测因素。预测死亡风险的阈值为血清肌酐1.495 mg/dL（敏感性：69.6%，特异性：81.8%）和eGFR 48.5 mL/min（敏感性：86.4%，特异性：69.5%）。这些阈值在评估死亡风险方面表现出色，血清肌酐的曲线下面积（AUC）为0.765，eGFR的AUC为0.786。
肾功能指标，特别是血清肌酐和eGFR，是急性中风患者死亡率和功能预后的重要预测因素。与缺血性中风相比，出血性中风与更高的死亡率和更差的肾功能相关。这些发现凸显了在中风管理中评估肾功能的重要性，并建议进行更大样本队列的进一步研究以完善中风预后的预测模型。
