Prognostic value of urine dipstick proteinuria on mortality after acute ischemic stroke.
Proteinuria is a marker of kidney disease and a strong risk factor for cardiovascular diseases including stroke. This study was aimed at investigating the prognostic value of proteinuria measured by urine dipstick in patients with acute ischemic stroke.



This post-hoc analysis of a prospective cohort study included 3404 consecutive patients who had been admitted for acute ischemic stroke between November 2005 and June 2013. Proteinuria was defined as a trace or more of protein on a urine dipstick test routinely performed at admission. Date and cause of death until December 31, 2013 were collected. We investigated the association of proteinuria with all-cause mortality, cardiovascular mortality (defined as ICD-10 codes I00-I99), and non-cardiovascular mortality.



Proteinuria was present in 12.8% of the 3404 patients. During the mean follow-up period of 3.56 ± 2.22 years, there were 681 cases of all-cause mortality (460 cardiovascular deaths and 221 non-cardiovascular deaths). Multivariate Cox regression analysis showed that the presence of proteinuria was an independent risk factor for all-cause mortality (adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.40-2.04), cardiovascular mortality (adjusted HR 1.65, 95% CI 1.31-2.08), and non-cardiovascular mortality (adjusted HR 1.59, 95% CI 1.13-2.23). Adding proteinuria to the multivariate Cox models moderately improved the model performance for all-cause mortality (integrated area under curve [95% CI]: from 0.800 [0.784-0.816] to 0.803 [0.788-0.818], p = 0.026).



Proteinuria, which was detected on a urine dipstick test, was a significant predictor of mortality after acute ischemic stroke.
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, South Korea.
Jinkwon
J
Kim
Department of Neurology, Ewha Womans University, Seoul, South Korea.
Tae-Jin
TJ
Song
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Dongbeom
D
Song
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Joonsang
J
Yoo
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Jang-Hyun
JH
Baek
Department of Biostatistics, Yonsei University College of Medicine, Seoul, South Korea.
Hye Sun
HS
Lee
Department of Biostatistics, Yonsei University College of Medicine, Seoul, South Korea.
Chung Mo
CM
Nam
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Hyo Suk
HS
Nam
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Young Dae
YD
Kim
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: jhheo@yuhs.ac.
Ji Hoe
JH
Heo
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000652:urine; D002545:Brain Ischemia / Q000401:mortality* / Q000652:urine*; D002318:Cardiovascular Diseases / Q000150:complications; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis*; D015203:Reproducibility of Results; D012307:Risk Factors; D020521:Stroke / Q000401:mortality* / Q000652:urine*
D015415:Biomarkers
Chronic Kidney Disease; Ischemic stroke; Mortality; Proteinuria