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Prognostic significance of proteinuria in stroke patients treated with intravenous thrombolysis
Author(s) -
Gensicke H.,
Frih A. A.,
Strbian D.,
Zini A.,
Pezzini A.,
Padjen V.,
Haueter M.,
Seiffge D. J.,
Mäkitie L.,
Traenka C.,
Poli L.,
MartinezMajander N.,
Putaala J.,
Bonati L. H.,
Sibolt G.,
Giovannini G.,
Curtze S.,
BeslacBumbasirevic L.,
Vandelli L.,
Lyrer P. A.,
Nederkoorn P. J.,
Tatlisumak T.,
Engelter S. T.
Publication year - 2017
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13179
Subject(s) - proteinuria , medicine , modified rankin scale , renal function , stroke (engine) , odds ratio , cardiology , kidney , mechanical engineering , ischemic stroke , ischemia , engineering
Background and purpose 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. Methods In this explorative multicenter IVT register based study, the presence of urine dipstick proteinuria (yes/no), reduced eGFR (<60 ml/min/1.73 m 2 ) 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 ( OR s) with 95% confidence intervals were calculated. Results Amongst 3398 patients, 881 (26.1%) had proteinuria and 623 (18.3%) reduced eGFR . Proteinuria [ OR adjusted 1.65 (1.37–2.00) and OR adjusted 1.52 (1.24–1.88)] and reduced eGFR [ OR adjusted 1.26 (1.01–1.57) and OR adjusted 1.34 (1.06–1.69)] were independently associated with poor functional outcome and death, respectively. After adding both renal markers to the models, proteinuria [ OR adjusted+eGFR 1.59 (1.31–1.93)] still predicted poor outcome whilst reduced eGFR [ OR adjusted+proteinuria 1.20 (0.96–1.50)] did not. Proteinuria was associated with symptomatic intracranial hemorrhage [ OR adjusted 1.54 (1.09–2.17)] but not reduced eGFR [ OR adjusted 0.96 (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 [ OR adjusted 2.16 (1.54–3.03)] and death [ OR adjusted 2.55 (1.69–3.84)]. Conclusion 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.