Association of renal biomarkers with 3-month and 1-year outcomes among critically ill acute stroke patients.
BACKGROUND
The comparative relationships of widely recognized biomarkers of renal injury with short-term and long-term outcomes among critically ill acute stroke patients are unknown. We evaluated the impact of baseline albuminuria [urine albumin-creatinine ratio (UACR) ≥ 30 mg/g] or low estimated glomerular filtration rate (eGFR<60 ml/min per 1.73 m(2)) on stroke patients admitted to the intensive care unit (ICU).


METHODS
We reviewed data on consecutive stroke patients admitted to a hospital ICU in Taiwan from September 2007 to August 2010 and followed-up for 1 year. Baseline UACR was categorized into <30 mg/g (normal), 30-299 mg/g (microalbuminuria), and ≥ 300 mg/g (macroalbuminuria), while eGFR was divided into ≥ 60, 45-59, and <45 ml/min per 1.73 m(2). The outcome measure was death or disability at 3-month and 1-year after stroke onset, assessed by dichotomizing the modified Rankin Scale at 3-6 versus 0-2.


RESULTS
Of 184 consecutive patients, 153 (83%) met study entry criteria. Mean age was 67.9 years and median admission NIHSS score was 16. Among the renal biomarkers, only macroalbuminuria was associated with poorer 3-month outcome (OR 8.44, 95% CI 1.38 to 51.74, P = 0.021) and 1-year outcome (OR 18.06, 95% CI 2.59 to 125.94, P = 0.003) after adjustment of relevant covariates. When ischemic and hemorrhagic stroke were analyzed separately, macroalbuminuria was associated with poorer 1-year outcome among ischemic (OR 17.10, 95% CI 1.04 to 280.07, P = 0.047) and hemorrhagic stroke patients (OR 1951.57, 95% CI 1.07 to 3561662.85, P = 0.048), respectively, after adjustment of relevant covariates and hematoma volume.


CONCLUSIONS
Presence of macroalbuminuria indicates poor 3-month and 1-year outcomes among critically ill acute stroke patients.
Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Ying-Chih
YC
Huang
Yi-Ling
YL
Wu
Ming-Hsueh
MH
Lee
Jiann-Der
JD
Lee
Chih-Ying
CY
Wu
Huan-Lin
HL
Hsu
Ya-Hui
YH
Lin
Yen-Chu
YC
Huang
Wen-Hung
WH
Huang
Hsu-Huei
HH
Weng
Jen-Tsung
JT
Yang
Meng
M
Lee
Bruce
B
Ovbiagele
D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000652:urine; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007362:Intensive Care Units; D007668:Kidney / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000652:urine*; D016019:Survival Analysis
D015415:Biomarkers; D003404:Creatinine