国家神经系统疾病临床医学研究中心数据管理与共享系统
Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
External Validation of the Nelson Equation for Kidney Function Decline in Patients with Acute Ischemic Stroke or Transient Ischemic Attack
第一作者：Hongyu Zhou
基本信息
- 负责人：Hongyu Zhou
- 数据来源： CNSR-Ⅲ
- 论文编号：CNSR-Ⅲ20200176
- 发表时间：2023-06-06
2023-06-06
已发表文章
发表杂志：Clinical Interventions in Aging
发表类型: Original Contributions
影响因子(IF): 3.829
PMID: 37304172 Pubmed原文链接 全文下载
主要研究背景及目的
Previous studies suggest a cross-talk between the brain and kidney after stroke.1 However, most research discussed the adverse effects of kidney disease on the of stroke prognosis. The effect of brain injury on kidney function remains unexplored. Recently, a new risk prediction equation for incident chronic kidney disease has been proposed.2 We aimed to validate this equation in patients with acute ischemic stroke or transient ischemic attack.
方法
A total of 3169 patients were enrolled in the Third China National Stroke Registry, whose baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2. The outcome of interest was the incident eGFR< 60 mL/min/1.73 m2 at 3 months. The prediction equation of participants with or without diabetes was validated respectively. The receiver operating characteristic curve (AUC) evaluated prediction performance. The Delong test compared the Nelson equation performance with the O’Seaghdha equation and the Chien equation. Continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were determined to evaluate the incremental effect.
结论
The Nelson equation reliably predicted the risks of the new-onset and long-term kidney function decline in patients with AIS or TIA, which could help clinicians screen high-risk patients and improve clinical care.
主要结果
During the 3-mo follow-up period, among 1151 patients with diabetes, there were 31 cases (2.7%) of reduced eGFR. Meanwhile, among 2018 non-diabetic patients, there were 23 cases (1.1%) of reduced eGFR. The Nelson equation showed good discrimination and was well-calibrated in patients with diabetes (AUC 0.82, Hosmer-Lemeshow test p = 0.67) or without diabetes (AUC 0.82, Hosmer-Lemeshow test p = 0.09). The performance of the Nelson equation was superior to other equation, as increased continuous NRI (diabetic, 0.64; non-diabetic, 1.13) and IDI (diabetic, 0.10; non-diabetic, 0.13) to the Chien equation.