Proteinuria and clinical outcomes after ischemic stroke
Kumai Y et al. – Chronic kidney disease (CKD) is an important predictor of poor clinical outcomes after acute ischemic stroke. Proteinuria independently contributes to the increased risks of neurologic deterioration, mortality, and poor functional outcome, but the estimated glomerular filtration rate (eGFR) may not be relevant to these outcomes.Methods
- The study subjects consisted of 3,778 patients with first-ever ischemic stroke within 24 hours of onset from the Fukuoka Stroke Registry.
- CKD was defined as proteinuria or low eGFR (<60 mL/min/m2) or both.
- The study outcomes were neurologic deterioration (≥2-point increase in the NIH Stroke Scale during hospitalization), in-hospital mortality, and poor functional outcome (modified Rankin Scale score at discharge of 2 to 6).
- The effects of CKD, proteinuria, and eGFR on these outcomes were evaluated using a multiple logistic regression analysis.
- CKD was diagnosed in 1,320 patients (34.9%).
- In the multivariate analyses after adjusting for confounding factors, patients with CKD had significantly higher risks of neurologic deterioration, in-hospital mortality, and poor functional outcome (p <0.001 for all).
- Among the CKD components, a higher urinary protein level was associated with an elevated risk of each outcome (p for trend < 0.001 for all), but no clear relationship between the eGFR level and each outcome was found.