title: Prognostic significance of proteinuria in stroke patients treated with intravenous thrombolysis.
abstract: Proteinuria and estimated glomerular filtration rate (eGFR) are indicators of renal function. Whether proteinuria better predicts outcome than eGFR in stroke patients treated with intravenous thrombolysis (IVT) remains to be determined.
  
  
  
  In this explorative multicenter IVT register based study, the presence of urine dipstick proteinuria (yes/no), reduced eGFR (<60 ml/min/1.73 m2) and the coexistence of both with regard to (i) poor 3-month outcome (modified Rankin Scale score 3-6), (ii) death within 3 months and (iii) symptomatic intracranial hemorrhage (ECASS-II criteria) were compared. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals were calculated.
  
  
  
  Amongst 3398 patients, 881 (26.1%) had proteinuria and 623 (18.3%) reduced eGFR. Proteinuria [ORadjusted1.65 (1.37-2.00) and ORadjusted1.52 (1.24-1.88)] and reduced eGFR [ORadjusted1.26 (1.01-1.57) and ORadjusted1.34 (1.06-1.69)] were independently associated with poor functional outcome and death, respectively. After adding both renal markers to the models, proteinuria [ORadjusted+eGFR1.59 (1.31-1.93)] still predicted poor outcome whilst reduced eGFR [ORadjusted+proteinuria1.20 (0.96-1.50)] did not. Proteinuria was associated with symptomatic intracranial hemorrhage [ORadjusted1.54 (1.09-2.17)] but not reduced eGFR [ORadjusted0.96 (0.63-1.62)]. In 234 (6.9%) patients, proteinuria and reduced eGFR were coexistent. Such patients were at the highest risk of poor outcome [ORadjusted2.16 (1.54-3.03)] and death [ORadjusted2.55 (1.69-3.84)].
  
  
  
  Proteinuria and reduced eGFR were each independently associated with poor outcome and death but the statistically strongest association appeared for proteinuria. Patients with coexistent proteinuria and reduced eGFR were at the highest risk of poor outcome and death.
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Gensicke
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: A A
authors.initials: AA
authors.lastname: Frih
authors.affiliation: Clinical Neurosciences, Neurology, University of Helsinki, and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: D
authors.identifier: 0000-0001-9095-2344
authors.initials: D
authors.lastname: Strbian
authors.affiliation: Stroke Unit, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Zini
authors.affiliation: Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Modena, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pezzini
authors.affiliation: Neurology Clinic, Clinical Centre of Serbia, Beograd, Serbia.
authors.forename: V
authors.initials: V
authors.lastname: Padjen
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Basel, Switzerland.|Neurorehabilitation Unit, Felix Platter Hospital, University of Basel and University Center for Medicine of Aging, Basel, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Haueter
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: D J
authors.initials: DJ
authors.lastname: Seiffge
authors.affiliation: Clinical Neurosciences, Neurology, University of Helsinki, and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Mäkitie
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Traenka
authors.affiliation: Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Modena, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Poli
authors.affiliation: Clinical Neurosciences, Neurology, University of Helsinki, and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: N
authors.initials: N
authors.lastname: Martinez-Majander
authors.affiliation: Clinical Neurosciences, Neurology, University of Helsinki, and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Putaala
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: L H
authors.initials: LH
authors.lastname: Bonati
authors.affiliation: Clinical Neurosciences, Neurology, University of Helsinki, and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: G
authors.initials: G
authors.lastname: Sibolt
authors.affiliation: Stroke Unit, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Giovannini
authors.affiliation: Clinical Neurosciences, Neurology, University of Helsinki, and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Curtze
authors.affiliation: Neurology Clinic, Clinical Centre of Serbia, Beograd, Serbia.
authors.forename: L
authors.initials: L
authors.lastname: Beslac-Bumbasirevic
authors.affiliation: Stroke Unit, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Vandelli
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: P A
authors.initials: PA
authors.lastname: Lyrer
authors.affiliation: Department of Neurology, Academic Medical Center Amsterdam, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.affiliation: Clinical Neurosciences, Neurology, University of Helsinki, and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.|Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.|Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Tatlisumak
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Basel, Switzerland.|Neurorehabilitation Unit, Felix Platter Hospital, University of Basel and University Center for Medicine of Aging, Basel, Switzerland.
authors.forename: S T
authors.initials: ST
authors.lastname: Engelter
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria / Q000150:complications*; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: glomerular filtration rate; intravenous thrombolysis; outcome; proteinuria; stroke