Renal Function Predicts Outcomes in Ischemic Stroke and Hemorrhagic Stroke (original) (raw)
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Predictors of in-hospital mortality after acute stroke: impact of renal dysfunction
Int. Journal of Clinical Pharmacology and Therapeutics, 2008
The purpose of this study was to identify predictors of in-hospital mortality after acute stroke and investigate the impact of gender on stroke mortality. All patients admitted to Al-watani governmental hospital in Palestine from September 2006 to August 2007 and diagnosed with acute stroke were included in the study. Diagnosis of stroke was confirmed by computerized tomography scan. Demographics and clinical data pertaining to the patients were obtained from their medical files. The main outcome measure in this study was vital status at hospital discharge. Multiple logistic regression analysis was used to identify the independent predictors of inhospital mortality. Statistical analysis was carried out using SPSS 15.A total of 186 acute stroke cases (95 females and 91 males) were included in the study. Hypertension (69.9%) and diabetes mellitus (45.2%) were the most common risk factors among the patients. Thirty nine (21%) of the stroke patients died in hospital. Multiple logistic regression analysis indicated that chronic kidney disease (P = 0.004), number of post-stroke complications (P= 0.037), and stroke subtype (P = 0.015) were independent predictors of in-hospital mortality among the total stroke patients. Knowledge of in-hospital mortality predictors is required to improve survival rate after acute stroke. The study showed that gender was not an independent predictor of mortality after acute stroke. More research is required to understand gender differences in stroke mortality.
Introduction: Stroke is considered the second leading cause of death globally. Chronic kidney disease (CKD) has been identified as a risk factor for stroke. However, little is known about the impact of renal dysfunction on early mortality following acute ischemic stroke. The aim of the current study was to evaluate the prevalence of renal dysfunction among acute ischemic stroke patients and its role on the early overall mortality. Patients and methods: This prospective cohort study included a total of 889 patients with first ever ischemic stroke who were hospitalized within 24 hours of symptoms onset. All patients were clinically evaluated to determine stroke risk factors. Stroke severity was assessed using National Institute of Health Stroke Scale (NIHSS) in the 1st day of admission. Baseline investigations were obtained within 24 hours of admission, including serum creatinine and estimated Glomerular Filtration Rate (eGFR) that was calculated from the equation of the Modification Diet for Renal Disease in ml/min/1.73m2. Patients were followed up for 30 days after admission or at least until death. Results: Of the 800 stroke patients who completed follow up during the study period, 242 (30.2%) had renal dysfunction, and 128 (16%) died within 30-days of stroke onset, whereas mortality was higher (19.8%) in patients with eGFR <60 ml/min/1.73m2 than in patients (14%) with eGFR ?60 ml/min/1.73m2. In multivariate analysis, 30–days mortality risk of stroke was higher in patients with eGFR< 60ml/min/1.73 m2 (HR= 1.7, 95% CI=1.4–2, P=0.002), stroke severity (HR= 1.5, 95% CI=1.3- 1.7, P=0.001), and presence of atrial fibrillation (HR= 1.4, 95% CI=1.1-1.7, P=0.007). Meanwhile, the odds of mortality risk increased by 1.7 for each 1 mg/dl increase in baseline serum creatinine. Conclusion: The prevalence of renal dysfunction in our cohort of acute ischemic stroke patients was high. Presence of baseline renal dysfunction was recorded as an independent predictor of early mortality in the setting of acute ischemic stroke beside other well-known prognostic factors.
Ischaemic stroke – impact of renal dysfunction on in-hospital mortality
European Journal of Neurology, 2007
Renal dysfunction predicts mortality in patients with myocardial infarction but less is known about the impact of renal dysfunction on in-hospital mortality after ischaemic stroke. All 361 patients (185 men, 176 women; mean age 72.1 years) with ischaemic stroke and glomerular filtration rate (GFR) <90 ml/min/1.73 m 2 were followed-up. GFR was calculated according to abbreviated modification of diet in renal disease (MDRD) formula. Stroke severity was determined by National Institutes of Health Stroke Scale (NIHSS). The mean GFR was 61.5 ± 16.6 ml/min/1.73 m 2 . There were 49 (13.6%) in-hospital deaths. Patients who died had higher NIHSS (P ¼ 0.0001), were older (P ¼ 0.024), had lower GFR (P ¼ 0.028), higher hs-C-reactive protein (P ¼ 0.001) and lower albumin (P ¼ 0.048). No differences in presence of diabetes and hypertension, cholesterol (total, HDL and LDL), triglycerides and BMI between patients who died or survived were found. With univariate analysis association between in-hospital mortality and NIHSS (P ¼ 0.0001), GFR (P ¼ 0.041), total cholesterol (P ¼ 0.021) and LDL cholesterol (P ¼ 0.034) was found. With Cox multivariable regression analysis of risk factors, NIHSS (P ¼ 0.0001), GFR (P ¼ 0.018), total cholesterol (P ¼ 0.008) and LDL cholesterol (P ¼ 0.011) were only predictors of in-hospital mortality. In patients with ischaemic stroke, decreased GFR was associated with higher in-hospital mortality.
Renal Function Abnormalities Among Hospitalized Stroke Patients
2022
BACKGROUND: Stroke is the leading cause of neurological disability and the second commonest cause of death globally. Despite the fact that renal dysfunction is a common comorbidity of stroke, there is no data on the prevalence of renal dysfunction among patients with acute stroke in Ethiopia. The aim of this study was to determine the magnitude of renal dysfunction, factors associated with renal dysfunction and risk of in-hospital mortality. METHODS: A hospital-based cross-sectional study was conducted in Yekatit 12 Hospital Medical College among consecutive 192 patients, who were admitted with acute stroke from September 2020 to September 2021. Data were collected using a structured questionnaire after pilot survey was done. A Multivariate binary logistic regression analysis was fitted to identify determinants of renal function abnormalities. Renal dysfunction was defined as serum creatinine >1.2mg/dl. RESULT: The mean age (SD) of study participants was 62.2 (15.9) years. Hundred-one (52.6%) participants were males. Thirty-four (17.7%) of the participants had renal dysfunction. Among patients with renal dysfunction, more than half of them were ≥70 years old and two-thirds were males. Male gender and hypertension increased the risk of renal dysfunction among hospitalized stroke patients. The mortality rate was higher in stroke patients with renal dysfunction (35.3%) as compared with patients having normal renal function (15.2%), but it was not a statistically significant. CONCLUSION: Renal dysfunction was a frequent comorbidity among acute stroke patients who were hospitalized. Male gender and hypertension were statistically significant predictors of renal dysfunction. Mortality rate was higher in stroke patients with renal dysfunction, but not a statistically significant predictor of post stroke in-hospital mortality.
Renal Function Abnormalities among Patients with Acute Stroke at a Tertiary Hospital in Ethiopia
PubMed, 2022
Background: Stroke is the leading cause of neurological disability and the second commonest cause of death globally. Despite the fact that renal dysfunction is a common comorbidity of stroke, there is no data on the prevalence of renal dysfunction among patients with acute stroke in Ethiopia. The aim of this study was to determine the magnitude of renal dysfunction, factors associated with renal dysfunction and risk of in-hospital mortality. Methods: A hospital-based cross-sectional study was conducted in Yekatit 12 Hospital Medical College among consecutive 192 patients, who were admitted with acute stroke from September 2020 to September 2021. Data were collected using a structured questionnaire after pilot survey was done. A Multivariate binary logistic regression analysis was fitted to identify determinants of renal function abnormalities. Renal dysfunction was defined as serum creatinine >1.2mg/dl. Result: The mean age (SD) of study participants was 62.2 (15.9) years. Hundred-one (52.6%) participants were males. Thirty-four (17.7%) of the participants had renal dysfunction. Among patients with renal dysfunction, more than half of them were ≥70 years old and two-thirds were males. Male gender and hypertension increased the risk of renal dysfunction among hospitalized stroke patients. The mortality rate was higher in stroke patients with renal dysfunction (35.3%) as compared with patients having normal renal function (15.2%), but it was not a statistically significant. Conclusion: Renal dysfunction was a frequent comorbidity among acute stroke patients who were hospitalized. Male gender and hypertension were statistically significant predictors of renal dysfunction. Mortality rate was higher in stroke patients with renal dysfunction, but not a statistically significant predictor of post stroke in-hospital mortality.
Renal function is associated with 1-month and 1-year mortality in patients with ischemic stroke
Atherosclerosis, 2017
Renal dysfunction is a potent risk factor for cardiovascular diseases, including stroke. This study aimed to evaluate the impact of admission estimated glomerular filtration rate (eGFR) levels on short-term (1-month) and long-term (1-year) mortality in patients with acute ischemic stroke. From the Taiwan Stroke Registry data, we classified ischemic stroke patients, identified from April 2006 to December 2015, into 5 groups by eGFR at admission: ≥ 90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m2 or on dialysis. Risks of 1-month mortality and 1-year mortality after ischemic stroke were investigated by the eGFR level. Among 52,732 ischemic stroke patients, 1480 died within one month. The 1-month mortality rate was over 5-fold greater in patients with eGFR <15 mL/min/1.73 m2 or dialysis than in patients with eGFR ≥90 mL/min/1.73 m2 (2.88 versus 0.56 per 1000 person-days). The adjusted hazard ratio (HR) of 1-month mortality increased from 1.31 (95% CI = 1.08-1.59) for patients with ...
Chronic Kidney Disease and Clinical Outcome in Patients With Acute Stroke
Stroke, 2009
Background and Purpose-Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for cardiovascular disease and stroke. Our aim was to examine the association between estimated glomerular filtration rate (GFR) and stroke outcome and to assess whether CKD and its severity affect stroke outcome in a large cohort of unselected patients with acute stroke. Methods-We examined the association between baseline estimated GFR and CKD and 1-year outcomes in 821 consecutive patients with acute stroke (ischemic or hemorrhagic). GFR was estimated by 2 methods: the Modification of Diet in Renal Disease and the Mayo Clinic quadratic equation. An estimated GFR rate Յ60 mL/min/1.73 m 2 defined CKD. Results-Odds ratios (95% CI) for death across levels of estimated GFR based on both equations were estimated. CKD was present in 36% of patients based on the Modification of Diet in Renal Disease equation and 18% (nϭ147) based on the Mayo Clinic equation. The adjusted ORs for mortality after 1-year based on the Modification of Diet in Renal Disease equation were 0.7 (95% CI, 0.4 to 1.2) associated with GFR 45 to 60 and 3.2 (1.7 to 6.4) associated with GFR 15 to 44 as compared with GFR Ͼ60 mL/min/1.73 m 2 , whereas those based on the Mayo Clinic equation were 2.3 (1.1 to 4.7) and 3.3 (1.6 to 7.1), respectively. The adjusted ORs for Barthel Index Յ75 or death after 1 year were 0.8 (0.5 to 1.5) and 2.1 (0.9 to 4.8) by the Modification of Diet in Renal Disease equation and 1.9 (0.8 to 4.4) and 3.9 (1.5 to 11.0) by the Mayo Clinic equation, respectively. Conclusions-CKD is a strong independent predictor of mortality and poor outcome in patients with acute stroke. The estimation of the prevalence of CKD and of the GFR cutoffs associated with poor outcome depend on the equation used to estimate GFR. (Stroke. 2009;40:1296-1303.)
Cardiology Journal, 2014
Background: The aim of our prospective study was to define the impact of renal dysfunction on future cardiovascular events and total mortality in 390 patients suffering from ischemic stroke. Methods: A quantitative measurement of neurologic deficit according to National Institutes of Health Stroke Scale (NIHSS) score was performed. Blood parameters were measured. Diabetes, hypertension and smoking habits were defined. Estimated glomerular filtration rate was calculated. Results: 153 (39.2%) patients had renal dysfunction. In the follow-up period in 36 (9.2%) patients acute coronary syndrome, in 102 (26.2%) recurrent ischemic stroke and in 44 (11.3%) peripheral arterial disease were documented. 191 (49%) patient died, 118 (30.3%) of whom died of cardiovascular events. Patients who died were older, had higher prevalence of renal dysfunction and NIHSS score. The Kaplan-Meier survival analysis showed that total mortality (p < 0.003) and cardiovascular mortality (p < 0.01) were higher in patients with renal dysfunction. According to Cox's regression analysis, renal dysfunction was the predictor of cardiovascular events, cardiovascular and total mortality. Conclusions: Patients with ischemic stroke and renal dysfunction are at higher risk for long term cardiovascular and total mortality. The patients with ischemic stroke and renal dysfunction are also at higher risk of new cardiovascular morbidity. Renal dysfunction should be added to the other known prognostic factors in patients with ischemic stroke. Our results also emphasize the importance of identification and management of renal dysfunction in stroke patients.