title: Low estimated glomerular filtration rate is associated with poor outcomes in patients who suffered a large artery atherosclerosis stroke.
abstract: OBJECTIVE
  The relationship between low estimated glomerular filtration rate (eGFR) and the outcome of ischemic stroke remains controversial, despite the close association between kidney dysfunction and atherosclerosis.
  
  
  METHODS
  This study conducted subgroup analysis using data from the prospective Taiwan Stroke Registry to investigate the relationship between eGFR at the time of admission and 6-month functional outcomes in patients with the large artery atherosclerotic (LAA) subtype of acute ischemic stroke. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and outcomes were defined as modified Rankin Scale and mortality status at 6 months post stroke.
  
  
  RESULTS
  Of the 8052 patients with the LAA subtype of acute ischemic stroke in this study, 3312 (41.1%) had eGFR <60 mL/min/1.73 m(2). The adjusted odds ratios of worse functional outcomes following a stroke were 1.10 (95% confidence interval [CI], 0.95-1.28), 1.60 (95% CI, 1.22-2.11) and 1.60 (95% CI, 1.10-2.33) in patients with eGFR 30-59, 15-29, and <15 as compared with those with eGFR 60-119 mL/min/1.73 m(2), respectively. Increased risk of mortality was closely and independently related to high NIHSS scores and low eGFR levels. Stroke severity and eGFR were also synergistically related to 6-month mortality, with an adjusted hazard ratio of 21.19 (95% CI, 9.69-46.35) in patients with NIHSS >15 and eGFR <15 mL/min/1.73 m(2), compared with those with NIHSS 0-5 and eGFR 60-119 mL/min/1.73 m(2).
  
  
  CONCLUSIONS
  Low eGFR was significantly and independently associated with 6-month functional outcomes and mortality in patients with the LAA subtype of acute ischemic stroke. The deleterious relationship between low eGFR levels and mortality following stroke was exacerbated by its synergistic association with stroke severity.
authors: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors: Shin-Joe
authors: SJ
authors: Yeh
authors: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors: Jiann-Shing
authors: JS
authors: Jeng
authors: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors: Sung-Chun
authors: SC
authors: Tang
authors: Department of Neurology, China Medical University Hospital, Taichung, Taiwan, ROC.
authors: Chung-Hsiang
authors: CH
authors: Liu
authors: Department of Neurology, E Da Hospital, Kaohsiung, Taiwan, ROC.
authors: Shih-Pin
authors: SP
authors: Hsu
authors: Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan, ROC.
authors: Chih-Hung
authors: CH
authors: Chen
authors: Department of Neurology, Shin Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan, ROC.
authors: Li-Ming
authors: LM
authors: Lien
authors: Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan, ROC.
authors: Huey-Juan
authors: HJ
authors: Lin
authors: Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC.
authors: Chiu-Mei
authors: CM
authors: Chen
authors: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
authors: Ruey-Tay
authors: RT
authors: Lin
authors: Department of Neurology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.
authors: Siu-Pak
authors: SP
authors: Lee
authors: Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors: Ching-Huang
authors: CH
authors: Lin
authors: Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan, ROC.
authors: Chung-Hsin
authors: CH
authors: Yeh
authors: Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan, ROC.
authors: Yu
authors: Y
authors: Sun
authors: Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan, ROC.
authors: Ming-Hui
authors: MH
authors: Sun
authors: Department of Neurology, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC.
authors: Jiu-Haw
authors: JH
authors: Yin
authors: Department of Public Health, China Medical University, Taichung, Taiwan, ROC.
authors: Che-Chen
authors: CC
authors: Lin
authors: Institute of Population Science, National Health Research Institute, Miaoli, Taiwan, ROC.
authors: Chi-Pang
authors: CP
authors: Wen
authors: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC. Electronic address: milikai@ntuh.gov.tw.
authors: Li-Kai
authors: LK
authors: Tsai
authors: Department of Public Health, China Medical University, Taichung, Taiwan, ROC. Electronic address: fcsung1008@yahoo.com.
authors: Fung-Chang
authors: FC
authors: Sung
authors: Graduate Institute of Clinical Medical Science, China Medical University and Hospital, Taichung, Taiwan, ROC.
authors: Chung Y
authors: CY
authors: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007511:Ischemia / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011786:Quality Control; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology; D020521:Stroke / Q000503:physiopathology*; D013624:Taiwan; D016896:Treatment Outcome
keywords: Atherosclerosis; Brain infarction; Glomerular filtration rate