Abstract
Background: Albuminuria [urine albumin-creatinine ratio (UACR) ≥ 30 mg/g] and low estimated glomerular filtration rate (eGFR < 60 ml/min per 1.73 m 2 ) have been separately associated with poor short-intermediate term outcomes after an index stroke. However, few studies have assessed the impact of both these indices of kidney dysfunction in the same acute stroke patient population; and especially not among critically ill stroke patients. We investigated the role of baseline UACR and eGFR as prognosticators for stroke patients admitted to the intensive care unit (ICU). Methods: We enrolled consecutive stroke patients admitted to a hospital ICU in Taiwan from September 2007 to August 2010 and followed-up for 1 year. UACR and eGFR were recorded at baseline. The primary outcome was poor functional outcome (mRS 3-6) at 1 year. Additional analyses subcategorized UACR into 30-299 and ≥ 300 mg/g, eGFR into 45-59 and < 45 ml/min per 1.73 m 2 , and stroke into ischemic and hemorrhagic stroke. Multivariable modeling adjusted for confounders. Results: There were 188 patients met entry criteria. Compared to patients with normal kidney function, patients with higher UACR had poorer 1-year functional outcomes whether they had normal eGFR (OR 2.76, 1.03-7.44, p=0.044) or low eGFR (OR 8.49, 2.84-25.39, p<0.001). Patients with low eGFR but normal UACR did not have poorer functional outcomes (OR 0.73, 0.19 to 2.90, p=0.685) (Table). Additional analyses showed that poor functional outcome was driven by baseline macroalbuminuria (OR 16.66, 2.58 to 107.64, p=0.003) vs. microalbuminuria (OR 2.01, 0.64 to 6.30, p=0.233). Separate analyses for ischemic and hemorrhagic stroke were similar to the overall findings. Conclusions: Higher baseline UACR, especially in the macroalbuminuric range, is an independent predictor of poor 1-year functional outcome among critically ill acute stroke patients regardless of stroke type. Baseline low eGFR does not appear to be a prognosticator in these patients.
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