Background: Chronic kidney disease (CKD), defined as a reduced glomerular filtration rate (GFR) or albuminuria, is associated with an increased risk of cardiovascular events, including stroke. However, the association between CKD and acute-phase stroke has not yet been thoroughly studied. We investigated the impact of estimated GFR (eGFR) and albuminuria on early neurological deterioration (END) in patients with acute ischemic stroke.
Methods: In this retrospective study, we enrolled 294 consecutive patients with acute ischemic stroke admitted to our stroke center from January 2011 to September 2012. General blood and urine examinations, including eGFR and urinary albumin/creatinine ratio (UACR), were performed on admission. Other risk factors and comorbidities were also examined. END was defined as a ≥ 2-point increase in the National Institutes of Health Stroke Scale (NIHSS) score within 7 days. Statistical significance between the END and non-END group was assessed using Pearson’s chi-square test for categorical variables. Multiple logistic regression analyses were performed to identify predictors of END.
Results: END was observed in 60 patients (20.4%). Age (P = 0.003), admission Blood glucose level (P = 0.036), large vessel disease (P = 0.022), small vessel disease (P < 0.001), UACR (P < 0.001), and admission NIHSS score (P < 0.001) were significantly associated with END, but no relationship between eGFR and END was found. The optimal cutoff level, sensitivity, and specificity of UACR levels to distinguish the END group from the non-END group were 39.6 mg/g creatinine, 83.3 and 52.1%, respectively. On multivariable logistic regression analysis showed that END was positively associated with high UACR (≥ 39.6 mg/g creatinine; odds ratio [OR], 3.36; 95% confidence interval [CI], 1.60-7.51; P = 0.0011) and high admission NIHSS score(≥ 6 points, OR, 2.27; 95% CI, 1.11-4.78; P = 0.0245), and negatively associated with diagnosis of small vessel disease (OR, 0.11; 95% CI, 0.0054-0.80; P = 0.0277).
Conclusions: Our data suggest that high UACR on admission may predict early neurological deterioration in patients with acute ischemic stroke. Larger prospective studies are further required to clarify the correlation between albuminuria and END.