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

Abstract

Background The 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. Methods We 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. Results A 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). Conclusions ICH 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.

Validation of diagnosis codes in healthcare databases in Taiwan, a literature review

“…In addition, disease‐specific registries (Stroke, 21,23 Primary aldosteronism, 18,79 and Tuberculosis 31 ) and electronic medical record systems in major hospital systems that provide comprehensive services (ambulatory care, pharmacy, emergency services and inpatient care), 80,81 although not entirely population‐based, are useful data sources for this purpose as well. Detailed description of medical records review mechanism has been described for the Chang Gung Research Database 41,82 …”

“…Detailed description of medical records review mechanism has been described for the Chang Gung Research Database. 41,82 In reviewing pharmacoepidemiology articles from Taiwan and personal communications with investigators, we are aware that validations of diagnosis codes have been conducted in convenience samples of subjects, but the findings have not been reported separately. With these validation findings embedded in articles for which the main findings were association between certain drug exposures and outcomes, literature search through keywords related to validation may not accurately identify all potential articles.…”

Comparison among demographics, risk factors, clinical manifestations, and outcomes of stroke subtypes: Findings from a Malaysian stroke-ready hospital

“…Previous studies showed similar results. 60,61 Stroke is one of the primary causes of morbidity and mortality in Malaysia, as it is in many other countries. With the growing proportion of elderly in the population and recent advancements in stroke prevention and treatment, the epidemiology of stroke is changing with time.…”