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The Association between Baseline and 3-Month Albuminuria and 1-Year Prognosis of Ischemic Stroke

First author：Dongxue Wang,Yuesong Pan

Corresponding author：Yilun Zhou,Yongjun Wang

Albuminuria changes Albumin-to-creatinine ratio Stroke Prognosis Mortality

essential_information

2021-08-25

Published articles

Journal：Cerebrovascular Diseases

Publication type: Clinical Study

IF(IF): 2.76

PMID: 34515069 Link To Pubmed Full text Download

Background And Purpose

蛋白尿是肾损害的重要临床表现之一，来自不同人群的临床研究均提示蛋白尿是全因死亡、心脑血管事件、终末期肾脏病等不良预后的独立风险因素。一项针对慢性肾脏病人群的队列研究还表明蛋白尿和肾小球滤过率相比，可以更强的预测脑卒中发生风险。另外，蛋白尿水平的变化也被证实可以独立于基线蛋白尿水平之外，预测临床不良结局事件。但是，脑卒中发病后蛋白尿水平的变化对卒中人群临床预后的作用尚未可知。我们猜测ACR发生变化的患者可能较ACR相对稳定的患者具有更高的不良预后事件发生风险。因此，本研究拟根据卒中患者基线和3个月两次ACR变化情况进行分组，分析ACR不同变化组对卒中一年预后（包括全因死亡、卒中复发和卒中致残）的影响。

Method

The patients with ischemic stroke or transient ischemic attack from the Third China National Stroke Registry (CNSR-III) who had the urinary albumin- to-creatinine ratio (ACR) detected at baseline and 3-month were recruited. They were classified into 4 groups according to baseline and 3-month ACR and followed up for 1 year.

Conclusion

Changes in albuminuria can predict adverse 1-year outcomes in Chinese ischemic stroke patients. In particular, persistent albuminuria was independently associated with 1-year all-cause death, stroke recurrence, and poor functional outcome.

Main results

A total of 5,311 patients were finally included in the study. There were 3,738 (70.4%), 483 (9.1%), 451 (8.5%), and 639 (12.0%) patients with no albuminuria, baseline albuminuria, 3-month albuminuria, and persistent albuminuria, respectively. After adjustment for confounding variables, persistent albuminuria was independently associated with all-cause death (hazard ratio [HR], 2.23; 95% CI, 1.17–4.25; p = 0.02), stroke recurrence (HR, 1.55; 95% CI, 1.02–2.36; p = 0.04), and poor functional outcome (OR, 2.22; 95% CI, 1.66– 2.96; p < 0.001). Baseline albuminuria was independently associated with poor functional outcome (OR, 1.65; 95% CI, 1.19–2.28; p = 0.003), while 3-month albuminuria was independently associated with stroke recurrence (HR, 1.68; 95% CI, 1.06–2.65; p = 0.03).