Influence of Estimated Glomerular Filtration Rate on Clinical Outcomes in Patients with Acute Ischemic Stroke Not Receiving Reperfusion Therapies.

Mi-Yeon Eun,Kyung-Hee Cho,Sungwook Yu,Jin-Woo Park,Bang-Hoon Cho

doi:10.3390/jcm10204719

Abstract

Background: We aimed to determine whether estimated glomerular filtration rate (eGFR) is an independent predictor of clinical outcomes in patients with acute ischemic stroke not treated with reperfusion therapy. Methods: A total of 1420 patients with acute ischemic stroke from a hospital-based stroke registry were included in this study. Patients managed with intravenous thrombolysis or endovascular reperfusion therapy were excluded. The included patients were categorized into five groups according to eGFR, as follows: ≥90, 60–89, 45–59, 30–44, and <30 mL/min/1.73 m2. The effects of eGFR on functional outcome at discharge, in-hospital mortality, neurologic deterioration, and hemorrhagic transformation were evaluated using logistic regression analyses. Results: In univariable logistic regression analysis, reduced eGFR was associated with poor functional outcome at discharge (p < 0.001) and in-hospital mortality (p = 0.001), but not with neurologic deterioration and hemorrhagic transformation. However, no significant associations were observed between eGFR and any clinical outcomes in multivariable analysis after adjusting for clinical and laboratory variables. Conclusions: Reduced eGFR was associated with poor functional outcomes at discharge and in-hospital mortality but was not an independent predictor of short-term clinical outcomes in patients with acute ischemic stroke who did not undergo reperfusion therapy.

Highlights

Chronic kidney disease (CKD) is an established risk factor for cardiovascular disease that substantially contributes to morbidity and mortality [1,2]
We excluded 185 patients with transient ischemic attack, 126 patients managed with reperfusion therapy, 360 patients who were not evaluated for estimated glomerular filtration rate (eGFR), and 163 patients without clinical outcome data
The present study showed that decreased eGFR tended to increase the risk of poor functional outcome at discharge, in-hospital mortality, and hemorrhagic transformation in patients with acute ischemic stroke who did not undergo intravenous thrombolysis or endovascular reperfusion therapy

Summary

Introduction

Chronic kidney disease (CKD) is an established risk factor for cardiovascular disease that substantially contributes to morbidity and mortality [1,2]. Other studies have reported that reduced eGFR was not related to functional outcome or mortality at discharge or 90 days following acute stroke, after adjusting for other vascular risk factors [6,9,10]. We aimed to determine whether estimated glomerular filtration rate (eGFR) is an independent predictor of clinical outcomes in patients with acute ischemic stroke not treated with reperfusion therapy. Results: In univariable logistic regression analysis, reduced eGFR was associated with poor functional outcome at discharge (p < 0.001) and in-hospital mortality (p = 0.001), but not with neurologic deterioration and hemorrhagic transformation. Conclusions: Reduced eGFR was associated with poor functional outcomes at discharge and in-hospital mortality but was not an independent predictor of short-term clinical outcomes in patients with acute ischemic stroke who did not undergo reperfusion therapy

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