Abstract
BackgroundThe comparative relationships of widely recognized biomarkers of renal injury with short-term and long-term outcomes among critically ill acute stroke patients are unknown. We evaluated the impact of baseline albuminuria [urine albumin-creatinine ratio (UACR)≥30 mg/g] or low estimated glomerular filtration rate (eGFR<60 ml/min per 1.73 m2) on stroke patients admitted to the intensive care unit (ICU).MethodsWe reviewed data on consecutive stroke patients admitted to a hospital ICU in Taiwan from September 2007 to August 2010 and followed-up for 1 year. Baseline UACR was categorized into <30 mg/g (normal), 30–299 mg/g (microalbuminuria), and ≥300 mg/g (macroalbuminuria), while eGFR was divided into ≥60, 45–59, and <45 ml/min per 1.73 m2. The outcome measure was death or disability at 3-month and 1-year after stroke onset, assessed by dichotomizing the modified Rankin Scale at 3–6 versus 0–2.ResultsOf 184 consecutive patients, 153 (83%) met study entry criteria. Mean age was 67.9 years and median admission NIHSS score was 16. Among the renal biomarkers, only macroalbuminuria was associated with poorer 3-month outcome (OR 8.44, 95% CI 1.38 to 51.74, P = 0.021) and 1-year outcome (OR 18.06, 95% CI 2.59 to 125.94, P = 0.003) after adjustment of relevant covariates. When ischemic and hemorrhagic stroke were analyzed separately, macroalbuminuria was associated with poorer 1-year outcome among ischemic (OR 17.10, 95% CI 1.04 to 280.07, P = 0.047) and hemorrhagic stroke patients (OR 1951.57, 95% CI 1.07 to 3561662.85, P = 0.048), respectively, after adjustment of relevant covariates and hematoma volume.ConclusionsPresence of macroalbuminuria indicates poor 3-month and 1-year outcomes among critically ill acute stroke patients.
Highlights
Albuminuria and low estimated glomerular filtration rate, the two most widely recognized indices of kidney dysfunction, have separately been linked to poorer outcomes after an index stroke [1,2,3,4,5]
Studies assessing the relationship of these renal biomarkers to acute stroke outcomes have generally been focused on albuminuria or estimated glomerular filtration rate (eGFR), only one stroke type, and short-term outcomes [5,6,7,8]
Among 184 consecutive stroke patients admitted to Neurology and Neurosurgery Intensive Care Unit during this period of time, 4 patients were excluded due to admission after 72 hours of stroke onset, 25 patients were excluded due to unknown mRS or mRS$3 before index stroke, and 2 patients were excluded due to urine creatinine was missing
Summary
Albuminuria and low estimated glomerular filtration rate (eGFR), the two most widely recognized indices of kidney dysfunction, have separately been linked to poorer outcomes after an index stroke [1,2,3,4,5]. We conducted a hospital-based study to elucidate whether baseline biomarkers of kidney dysfunction are independently associated with short-term and long-term clinical outcomes among acute critically ill stroke patients. The comparative relationships of widely recognized biomarkers of renal injury with short-term and long-term outcomes among critically ill acute stroke patients are unknown. We evaluated the impact of baseline albuminuria [urine albumin-creatinine ratio (UACR)$30 mg/g] or low estimated glomerular filtration rate (eGFR, ml/min per 1.73 m2) on stroke patients admitted to the intensive care unit (ICU)
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