Kidney disease is a negative predictor of 30-day survival after acute ischaemic stroke.Nephron Clin Pract. 2009; 112(2):c79-85.NC
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.
Medical records of 312 consecutive patients admitted to Ostrołeka 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.
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).
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.