Characteristics of ischemic stroke and intracranial hemorrhage in patients with nephrotic syndrome

Wen-Yi Huang,Chien-Hung Chang,Kuo-Hsuan Chang,Chun-Wei Chang,Kuan-Hsing Chen,Hsiu-Chuan Wu,Chiung-Mei Chen

doi:10.1186/s12882-021-02415-w

Abstract

BackgroundThe incidence of cerebral stroke, including ischemic infarction and intracranial hemorrhage (ICH), increases in patients with nephrotic syndrome (NS). However, the clinical characteristics of patients with NS and stroke remain elusive. We aimed to investigate the clinical presentation and prognosis among patients with NS and ischemic stroke (IS) or ICH.MethodsWe conducted a population-based retrospective cohort study of patients with NS and acute stroke using the Chang Gung Research Database of Taiwan from January 1, 2001, to December 31, 2017. The participants were recruited from the 7 branches of Chang Gung Memorial Hospital.ResultsA total of 233 patients with IS and 57 patients with ICH were enrolled. The median age was 60 (52–70) years. The prevalence rates of hyperlipidemia, hyperuricemia, and smoking were higher in IS than in ICH. IS demonstrated lower white blood cell count (7.80 vs. 8.92 × 109/L) and high-sensitivity C-reactive protein level (33.42 vs. 144.10 nmol/L) and higher cholesterol (5.74 vs. 4.84 mmol/L), triglyceride (1.60 vs. 1.28 mmol/L), and albumin (24 vs. 18 g/L) levels compared with ICH. The dependent functional status and 30-day mortality were higher in ICH than in IS. The risk factors for 30-day mortality for patients with NS and stroke were coronary artery disease (CAD), ICH, and total anterior circulation syndrome. The multivariate Cox regression analysis revealed that CAD was positively associated with 30-day mortality in patients with IS (hazard ratio 24.58, 95 % CI 1.48 to 408.90). In patients with ICH, CAD and subarachnoid hemorrhage were positively associated with 30-day mortality (hazard ratio 5.49, 95 % CI 1.54 to 19.56; hazard ratio 6.32, 95 % CI 1.57 to 25.53, respectively).ConclusionsICH demonstrated a higher risk of dependence and 30-day mortality compared with IS in patients with NS. Intensive monitoring and treatment should be applied particularly in patients with NS and ICH.

Highlights

The incidence of cerebral stroke, including ischemic infarction and intracranial hemorrhage (ICH), increases in patients with nephrotic syndrome (NS)
Patient selection We recruited in hospitalization records of patients in Chang Gung (CG) Research Databases from January 1, 2001, to December 31, 2017, using the NS-related ICD-9-CM or ICD-10-CM codes, and 3352 hospitalization records were identified
After excluding 1503 patients that did not present with NS, and 1559 patients that are not admitted with the diagnosis of acute stroke, we obtained 290 patients, including 233 patients with ischemic stroke (IS) and 57 patients with ICH, for further analysis (Supplementary Figure 1)

Summary

Introduction

The incidence of cerebral stroke, including ischemic infarction and intracranial hemorrhage (ICH), increases in patients with nephrotic syndrome (NS). Intracranial hemorrhage (ICH) is seen in patients with NS [9,10,11] This cerebral hemorrhage, which could be associated with intravascular deposition of immune complexes or systemic amyloidosis [12,13,14], can occur in patients with NS without stroke risk factors [11, 15, 16]. Biochemical abnormalities, such as proteinuria, D-dimer levels, hyperlipidemia, and renal function impairment, are associated with the occurrence of ICH in patients with NS [11]. The small numbers of patients in these studies limit further understanding of the clinical outcome and potential pathogenesis in this subpopulation of patients

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