title: Low baseline urine creatinine excretion rate predicts poor outcomes among critically ill acute stroke patients.
abstract: Urinary creatinine excretion rate (CER) is an established marker of muscle mass. Low CER has been linked to poor coronary artery disease outcomes, but a link between CER and acute stroke prognosis has not been previously explored. We prospectively collected data from patients with acute stroke (ischemic or hemorrhagic) within 24 hours from symptom onset in a Neurological and Neurosurgery Intensive Care Unit in Taiwan. Baseline CER (mg/d) was calculated by urine creatinine concentration in morning spot urine multiplies 24-hour urine volume on the second day of admission. Patients were divided into 3 tertiles with highest, middle, and lowest CER. Primary endpoint was poor outcome defined as modified Rankin Scale 3-6 at 6 months. Among 156 critically ill acute stroke patients meeting study entry criteria, average age was 67.9 years, and 83 (53.2%) patients had ischemic stroke. Patients with lowest CER (vs. highest CER) had a high risk of poor outcome at 6-month after adjustment (odds ratio 4.96, 95% confidence interval 1.22 to 20.15, p value = 0.025). In conclusion, low baseline CER, a marker of muscle mass, was independently associated with poor 6-month outcome among critically ill acute stroke patients. We speculate that preservation of muscle mass through exercise or protein-energy supplement might be helpful for improving prognosis in severe stroke patients.
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Hsu
authors.forename: Yi-Ling
authors.initials: YL
authors.lastname: Wu
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Cheng
authors.forename: Jiann-Der
authors.initials: JD
authors.lastname: Lee
authors.forename: Ying-Chih
authors.initials: YC
authors.lastname: Huang
authors.forename: Ming-Hsueh
authors.initials: MH
authors.lastname: Lee
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Wu
authors.forename: Huan-Lin
authors.initials: HL
authors.lastname: Hsu
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Lin
authors.forename: Yen-Chu
authors.initials: YC
authors.lastname: Huang
authors.forename: Hsin-Ta
authors.initials: HT
authors.lastname: Yang
authors.forename: Jen-Tsung
authors.initials: JT
authors.lastname: Yang
authors.forename: Meng
authors.initials: M
authors.lastname: Lee
authors.affiliation: Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan. b8101099@gmail.com.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003404:Creatinine / Q000652:urine*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017595:Renal Plasma Flow; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020521:Stroke / Q000401:mortality / Q000503:physiopathology* / Q000652:urine*; D013624:Taiwan
chemical_list: D003404:Creatinine