Renal Dysfunction and In‐Hospital Outcomes in Patients With Acute Ischemic Stroke After Intravenous Thrombolytic Therapy
Background The impact of estimated glomerular filtration rate (eGFR) on clinical short‐term outcomes after stroke thrombolysis with tissue plasminogen activator remains controversial. Methods and Results We analyzed 18 320 ischemic stroke patients who received intravenous tissue plasminogen activato...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.012052 |
| _version_ | 1818484204392939520 |
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| author | Zhen‐Zhen Rao Hong‐Qiu Gu Xian‐Wei Wang Xue‐Wei Xie Xin Yang Chun‐Juan Wang Xingquan Zhao Ying Xian Yi‐Long Wang Zi‐Xiao Li Rui‐Ping Xiao Yong‐Jun Wang |
| author_facet | Zhen‐Zhen Rao Hong‐Qiu Gu Xian‐Wei Wang Xue‐Wei Xie Xin Yang Chun‐Juan Wang Xingquan Zhao Ying Xian Yi‐Long Wang Zi‐Xiao Li Rui‐Ping Xiao Yong‐Jun Wang |
| author_sort | Zhen‐Zhen Rao |
| collection | DOAJ |
| description | Background The impact of estimated glomerular filtration rate (eGFR) on clinical short‐term outcomes after stroke thrombolysis with tissue plasminogen activator remains controversial. Methods and Results We analyzed 18 320 ischemic stroke patients who received intravenous tissue plasminogen activator at participating hospitals in the Chinese Stroke Center Alliance between June 2015 and November 2017. Multivariate logistic regression models were used to evaluate associations between eGFR (<45, 45–59, 60–89, and ≥90 mL/min per 1.73 m2) and in‐hospital mortality and symptomatic intracerebral hemorrhage, adjusting for patient and hospital characteristics and the hospital clustering effect. Of the 18 320 patients receiving tissue plasminogen activator, 601 (3.3%) had an eGFR <45, 625 (3.4%) had an eGFR 45 to 59, 3679 (20.1%) had an eGFR 60 to 89, and 13 415 (73.2%) had an eGFR ≥90. As compared with eGFR ≥90, eGFR values <45 (6.7% versus 0.9%, adjusted odds ratio, 3.59; 95% CI, 2.18–5.91), 45 to 59 (4.0% versus 0.9%, adjusted odds ratio, 2.00; 95% CI, 1.18–3.38), and 60 to 89 (2.5% versus 0.9%, adjusted odds ratio, 1.67; 95% CI, 1.20–2.34) were independently associated with increased odds of in‐hospital mortality. However, there was no statistically significant association between eGFR and symptomatic intracerebral hemorrhage. Conclusions eGFR was associated with an increased risk of in‐hospital mortality in acute ischemic stroke patients after treatment with tissue plasminogen activator. eGFR is an important predictor of poststroke short‐term death but not of symptomatic intracerebral hemorrhage. |
| first_indexed | 2024-12-10T15:52:01Z |
| format | Article |
| id | doaj.art-f94bb89f6e28495697d3d661c3038c36 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-10T15:52:01Z |
| publishDate | 2019-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f94bb89f6e28495697d3d661c3038c362022-12-22T01:42:47ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-10-0182010.1161/JAHA.119.012052Renal Dysfunction and In‐Hospital Outcomes in Patients With Acute Ischemic Stroke After Intravenous Thrombolytic TherapyZhen‐Zhen Rao0Hong‐Qiu Gu1Xian‐Wei Wang2Xue‐Wei Xie3Xin Yang4Chun‐Juan Wang5Xingquan Zhao6Ying Xian7Yi‐Long Wang8Zi‐Xiao Li9Rui‐Ping Xiao10Yong‐Jun Wang11Institute of Molecular Medicine, Yingjie Center Peking University Beijing ChinaChina National Clinical Research Center for Neurological Diseases Beijing ChinaChina National Clinical Research Center for Neurological Diseases Beijing ChinaChina National Clinical Research Center for Neurological Diseases Beijing ChinaChina National Clinical Research Center for Neurological Diseases Beijing ChinaChina National Clinical Research Center for Neurological Diseases Beijing ChinaChina National Clinical Research Center for Neurological Diseases Beijing ChinaDuke Clinical Research Institute Duke University Medical Center Durham NCChina National Clinical Research Center for Neurological Diseases Beijing ChinaChina National Clinical Research Center for Neurological Diseases Beijing ChinaInstitute of Molecular Medicine, Yingjie Center Peking University Beijing ChinaChina National Clinical Research Center for Neurological Diseases Beijing ChinaBackground The impact of estimated glomerular filtration rate (eGFR) on clinical short‐term outcomes after stroke thrombolysis with tissue plasminogen activator remains controversial. Methods and Results We analyzed 18 320 ischemic stroke patients who received intravenous tissue plasminogen activator at participating hospitals in the Chinese Stroke Center Alliance between June 2015 and November 2017. Multivariate logistic regression models were used to evaluate associations between eGFR (<45, 45–59, 60–89, and ≥90 mL/min per 1.73 m2) and in‐hospital mortality and symptomatic intracerebral hemorrhage, adjusting for patient and hospital characteristics and the hospital clustering effect. Of the 18 320 patients receiving tissue plasminogen activator, 601 (3.3%) had an eGFR <45, 625 (3.4%) had an eGFR 45 to 59, 3679 (20.1%) had an eGFR 60 to 89, and 13 415 (73.2%) had an eGFR ≥90. As compared with eGFR ≥90, eGFR values <45 (6.7% versus 0.9%, adjusted odds ratio, 3.59; 95% CI, 2.18–5.91), 45 to 59 (4.0% versus 0.9%, adjusted odds ratio, 2.00; 95% CI, 1.18–3.38), and 60 to 89 (2.5% versus 0.9%, adjusted odds ratio, 1.67; 95% CI, 1.20–2.34) were independently associated with increased odds of in‐hospital mortality. However, there was no statistically significant association between eGFR and symptomatic intracerebral hemorrhage. Conclusions eGFR was associated with an increased risk of in‐hospital mortality in acute ischemic stroke patients after treatment with tissue plasminogen activator. eGFR is an important predictor of poststroke short‐term death but not of symptomatic intracerebral hemorrhage.https://www.ahajournals.org/doi/10.1161/JAHA.119.012052glomerular filtration rateischemic strokeoutcomerenal functiontissue‐type plasminogen activator |
| spellingShingle | Zhen‐Zhen Rao Hong‐Qiu Gu Xian‐Wei Wang Xue‐Wei Xie Xin Yang Chun‐Juan Wang Xingquan Zhao Ying Xian Yi‐Long Wang Zi‐Xiao Li Rui‐Ping Xiao Yong‐Jun Wang Renal Dysfunction and In‐Hospital Outcomes in Patients With Acute Ischemic Stroke After Intravenous Thrombolytic Therapy Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease glomerular filtration rate ischemic stroke outcome renal function tissue‐type plasminogen activator |
| title | Renal Dysfunction and In‐Hospital Outcomes in Patients With Acute Ischemic Stroke After Intravenous Thrombolytic Therapy |
| title_full | Renal Dysfunction and In‐Hospital Outcomes in Patients With Acute Ischemic Stroke After Intravenous Thrombolytic Therapy |
| title_fullStr | Renal Dysfunction and In‐Hospital Outcomes in Patients With Acute Ischemic Stroke After Intravenous Thrombolytic Therapy |
| title_full_unstemmed | Renal Dysfunction and In‐Hospital Outcomes in Patients With Acute Ischemic Stroke After Intravenous Thrombolytic Therapy |
| title_short | Renal Dysfunction and In‐Hospital Outcomes in Patients With Acute Ischemic Stroke After Intravenous Thrombolytic Therapy |
| title_sort | renal dysfunction and in hospital outcomes in patients with acute ischemic stroke after intravenous thrombolytic therapy |
| topic | glomerular filtration rate ischemic stroke outcome renal function tissue‐type plasminogen activator |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.012052 |
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