Kidney Disease Is a Negative Predictor of 30-Day Survival after Acute Ischaemic Stroke

Abstract

Background/Aims: Impaired renal function is a strong risk factor for cardiovascular diseases and worsens a patient’s prognosis. Renal dysfunction predicts mortality after acute stroke in the long term. On the other hand, in-hospital mortality after acute stroke is strongly associated with disorders of consciousness at the onset of stroke, severity of stroke, body temperature, blood sugar and some other comorbidities. The aim of the study was to analyze the possible role of renal dysfunction and/or signs of renal disease (proteinuria) on 30-day mortality after acute ischaemic stroke (AIS) based on the hospital medical records of one county. Methods: Medical records of 312 consecutive patients admitted to Ostrołęka County Hospital (Department of Neurology) between March 2000 and October 2002 for AIS were retrieved retrospectively to determine factors influencing 30-day survival. None of patients received thrombolytic therapy. Results: Among the patients analyzed, 74 (23.7%) died during the 30-day period. In a simple Cox proportional hazards regression model, negative predictive factors were: older age, higher pulse rate, lower estimated glomerular filtration rate (eGFR), proteinuria, elevated plasma glucose level, diabetes mellitus, atrial fibrillation and chronic heart failure. In a multivariate analysis, independent negative predictors of 30-day morbidity were: age hazard ratio (HR) 1.05 (95% CI 1.02–1.08), eGFR <60 ml/min HR 1.75 (95% CI 1.21–2.19), dipstick proteinuria HR 2.28 (95% CI 1.74–2.82) and plasma glucose level >100 mg/dl HR 2.96 (95% CI 2.22–3.70). Conclusion: The results of this study identify decreased eGFR and presence of dipstick proteinuria as a strong negative predictor of 30-day survival after AIS in patients not treated with thrombolytic agents.

Clinical Features and Neurologic Severity in Stroke Patients with Mild to Moderate Renal Dysfunction

“…Carter et al 42 showed that the creatinine level was a predictor of mortality in patients with ischemic stroke. Hojs Fabjan et al 43 and Brzosko et al 44 showed that a low GFR was associated with a higher in-hospital mortality rate. Yahalom et al 26 showed that 45.1% of the patients in their series who had a GFR .60 mL per minute per 1.73 m 2 had an NIHSS score worse than 6, while 56.4% of the patients in their series with a GFR of 15 to 60 mL per minute per 1.73 m 2 showed a corresponding severity.…”

Association of Glomerular Filtration Rate With Outcomes of Acute Stroke in Type 2 Diabetic Patients: Results From the China National Stroke Registry

“…Some studies suggested that reduced eGFR is associated with a poor outcome in ischemic stroke patients (18,19), whereas other studies do not (20,21). Mittleman and colleagues (19) recently demonstrated that a reduced or highly elevated eGFR (,60 or .125 mL/min/1.73 m 2 ) was associated with a higher mortality rate compared with patients with moderate levels of eGFR in 1,175 acute ischemic stroke patients.…”

Baseline Renal Dysfunction in Acute Ischemic Stroke Patients: Prevalence and Impact on Early Mortality.

“…Furthermore, other studies showed that low eGFR was associated with a higher in-hospital mortality rates. 3,34 Data from Nationwide Inpatient Sample study showed that among 1 million of stroke hospitalizations during the study period, 6.1% had a co-morbid diagnosis of CKD, and 9% of those with CKD died in hospital. Presence of CKD was independently associated with higher odds of dying during stroke hospitalization regardless of stroke type 8 .…”