Relalionship between microaibuminuria and severity of acute ischemic stroke and outcomes

Abstract

Objective To investigate the relationship between microalbuminuria （MAU） and the risk factor for acute ischemic stroke, the severity of the disease and outcomes. Methods A total of 156 consecutive patients with acute ischemic stroke were enrolled prospectively. They were randomly divided into either an MAU positive group （≥ 30 mg/g） or an MAU negative group （ 〈 30 mg/g） according to urinary albumin/creatinine ratio （UACR）. They were also randomly divided into either a good outcome group （0 -2） or a poor outcome group （〉2） according to the modified Rankin scale （mRS） scores. The various demographic and clinical data were compared, and the poor outcome of acute ischemic stroke and the inde- pendent factors of positive MAU were analyzes.Results A total of 156 patients with acute ischemic stroke were enrolled, including 84 males and 72 female; aged 53 to 78 years （mean 65.4 ± 6. 2）; the time from on- set to admission was 1.5 to 28 h; 94 patients had good outcomes, 62 had poor outcomes, and no one died; MAU was positive in 76 patients and MAU was negative in 80 ones. Multivariate logistic regression analysis showed that advanced age （odds ratio [ OR] 1.992, 95% confidence interval [CI] 1. 108 - 2. 374; P = 0. 015）, complicated with diabetes （OR 2. 497, 95% CI 1. 177 -5.298; P =0. 017） and atrial fibrillation （OR 2. 338, 95% CI 1. 062 - 5. 148; P = 0. 035）, high serum homocysteine （Hcy） level （OR 2. 541, 95% CI 1. 073 - 6. 02; P = 0. 047） and UACR （OR 2. 130, 95 % CI 1. 396 - 3.017; P = 0. 001 ）, MAU positive （OR 3. 291, 95% CI 1. 681 -6. 444; P =0. 001）, high baseline National Institutes of Health Stroke Scale （NIHSS） score （OR 9. 196, 95% CI 2. 828- 19. 815; P〈 0. 001 ） were the independent risk factors for poor outcomes in patients with acute ischemic stroke. There were significant differences in the proportion of the patients complicated with diabetes （P =0. 038） and fasting blood glucose level （P =0. 025）, serum Hcy level （P =0. 022）, and carotid intima-media thickness （IMT） （P =0. 019） between the MAU positive group and the MAU negative group. The proportion of anterior circulation infarction was lower （P =0. 033）, the rates of the baseline NIHSS score （P =0. 003） and poor outcome were higher in the MAU positive group （P 〈 0. 001 ）. Multivariate logistic regression analysis showed that increased diabetes （OR 2.237, 95% CI 1. 036 - 4. 829; P =0. 040） and fasting blood glucose （OR 1. 223, 95% CI 1. 145 - 1. 673; P =0. 027）, the increased Hey level （OR 2.542, 95% CI 1.047-6.612; P=0.025）, carotid artery IMT （OR 1.295, 95% CI 1. 106 - 1. 362; P =0. 023） and baseline NIHSS score （OR1. 206, 95% CI 1. 044 - 1. 219; P =0. 023） were correlated independently with the positive MAU in patients with acute ischemic stroke. Conclusions Positive MAU is one of the independent risk factors for poor outcomes of acute ischemic stroke, it is closely associated with some risk factors for acute ischemic stroke, and it has a significant impact on the severity of acute ischemic stroke and outcomes. Key words: Stroke; Brain Ischemia; Albuminuria; Creatinine; Atherosclerosis; Severity of Illness Index; Treatment Outcome; Risk Factors