Estimated glomerular filtration rate and risk of poor outcomes after stroke

Priya Vart* (Corresponding Author), Raphae S. Barlas, Joao H. Bettencourt-Silva, Anthony K. Metcalf, Kristian M. Bowles, John F. Potter, Phyo K. Myint

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Relationship of estimated glomerular filtration rate (eGFR) with complications after stroke has not been fully characterized for entire clinical spectrum of eGFR and for the fluctuation in eGFR during hospital stay.

Methods: Data from the Norfolk and Norwich Stroke Registry recorded between January 2003 and April 2015 was analysed. eGFR was categorized into six clinically relevant categories as per Kidney Disease Improving Global Outcomes guidelines. Change in eGFR during acute admission was categorized into: within 5% change (ref.), 5-20% decline, >20% decline, 5-20% increase and >20% increase. All-cause mortality, recurrent stroke, incident myocardial infarction, prolonged hospital stay and stroke disability at discharge were outcomes of interest.

Results: 10,329 stroke patients (mean age 77.8 years) were followed for a mean of 2.9 years (30,126 person years). Multivariable adjusted hazard ratios (HRs) (95%CI) for all-cause mortality were 0.91 (0.80-1.04), 0.96 (0.83-1.11), 1.23 (1.06-1.43), 1.54 (1.31-1.82) and 2.38 (1.91-2.97) for eGFR levels 60-89, 45-59, 30-44, 15-29 and <15 respectively, compared to eGFR ≥90 mL/min/1.73m2. The HR (95%CI) for eGFR change were 1.56 (1.36-1.79), 1.17 (1.05-1.30), 1.47 (1.32-1.62) and 1.71 (1.55-1.88) for >20% decline, 5-20% decline, 5-20% increase and >20 % increase, respectively, compared to change within 5%. Results were similar for other outcomes except recurrent stroke.

Conclusions: Stroke patients with eGFR <45 mL/min/1.73m2 at hospital admission and > 5% decline or increase in eGFR during hospital stay were at substantially high risk of poor outcomes, particularly all-cause mortality, myocardial infarction, prolonged hospital stay and disability at discharge.
Original languageEnglish
Pages (from-to)1455-1463
Number of pages9
JournalEuropean Journal of Neurology
Volume26
Issue number12
Early online date17 Jul 2019
DOIs
Publication statusE-pub ahead of print - 17 Jul 2019

Fingerprint

Glomerular Filtration Rate
Stroke
Length of Stay
Mortality
Myocardial Infarction
Kidney Diseases
Registries
Guidelines

Keywords

  • eGFR
  • stroke
  • prognosis
  • mortality
  • disability
  • all-cause
  • chronic kidney-disease
  • EGFR
  • MORTALITY
  • ALL-CAUSE
  • CHRONIC KIDNEY-DISEASE

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Vart, P., Barlas, R. S., Bettencourt-Silva, J. H., Metcalf, A. K., Bowles, K. M., Potter, J. F., & Myint, P. K. (2019). Estimated glomerular filtration rate and risk of poor outcomes after stroke. European Journal of Neurology, 26(12), 1455-1463. https://doi.org/10.1111/ene.14026

Estimated glomerular filtration rate and risk of poor outcomes after stroke. / Vart, Priya (Corresponding Author); Barlas, Raphae S.; Bettencourt-Silva, Joao H.; Metcalf, Anthony K.; Bowles, Kristian M.; Potter, John F.; Myint, Phyo K.

In: European Journal of Neurology, Vol. 26, No. 12, 12.2019, p. 1455-1463.

Research output: Contribution to journalArticle

Vart, P, Barlas, RS, Bettencourt-Silva, JH, Metcalf, AK, Bowles, KM, Potter, JF & Myint, PK 2019, 'Estimated glomerular filtration rate and risk of poor outcomes after stroke', European Journal of Neurology, vol. 26, no. 12, pp. 1455-1463. https://doi.org/10.1111/ene.14026
Vart P, Barlas RS, Bettencourt-Silva JH, Metcalf AK, Bowles KM, Potter JF et al. Estimated glomerular filtration rate and risk of poor outcomes after stroke. European Journal of Neurology. 2019 Dec;26(12):1455-1463. https://doi.org/10.1111/ene.14026
Vart, Priya ; Barlas, Raphae S. ; Bettencourt-Silva, Joao H. ; Metcalf, Anthony K. ; Bowles, Kristian M. ; Potter, John F. ; Myint, Phyo K. / Estimated glomerular filtration rate and risk of poor outcomes after stroke. In: European Journal of Neurology. 2019 ; Vol. 26, No. 12. pp. 1455-1463.
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abstract = "Background: Relationship of estimated glomerular filtration rate (eGFR) with complications after stroke has not been fully characterized for entire clinical spectrum of eGFR and for the fluctuation in eGFR during hospital stay.Methods: Data from the Norfolk and Norwich Stroke Registry recorded between January 2003 and April 2015 was analysed. eGFR was categorized into six clinically relevant categories as per Kidney Disease Improving Global Outcomes guidelines. Change in eGFR during acute admission was categorized into: within 5{\%} change (ref.), 5-20{\%} decline, >20{\%} decline, 5-20{\%} increase and >20{\%} increase. All-cause mortality, recurrent stroke, incident myocardial infarction, prolonged hospital stay and stroke disability at discharge were outcomes of interest.Results: 10,329 stroke patients (mean age 77.8 years) were followed for a mean of 2.9 years (30,126 person years). Multivariable adjusted hazard ratios (HRs) (95{\%}CI) for all-cause mortality were 0.91 (0.80-1.04), 0.96 (0.83-1.11), 1.23 (1.06-1.43), 1.54 (1.31-1.82) and 2.38 (1.91-2.97) for eGFR levels 60-89, 45-59, 30-44, 15-29 and <15 respectively, compared to eGFR ≥90 mL/min/1.73m2. The HR (95{\%}CI) for eGFR change were 1.56 (1.36-1.79), 1.17 (1.05-1.30), 1.47 (1.32-1.62) and 1.71 (1.55-1.88) for >20{\%} decline, 5-20{\%} decline, 5-20{\%} increase and >20 {\%} increase, respectively, compared to change within 5{\%}. Results were similar for other outcomes except recurrent stroke.Conclusions: Stroke patients with eGFR <45 mL/min/1.73m2 at hospital admission and > 5{\%} decline or increase in eGFR during hospital stay were at substantially high risk of poor outcomes, particularly all-cause mortality, myocardial infarction, prolonged hospital stay and disability at discharge.",
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T1 - Estimated glomerular filtration rate and risk of poor outcomes after stroke

AU - Vart, Priya

AU - Barlas, Raphae S.

AU - Bettencourt-Silva, Joao H.

AU - Metcalf, Anthony K.

AU - Bowles, Kristian M.

AU - Potter, John F.

AU - Myint, Phyo K.

N1 - We thank the data team of the Norfolk and Norwich University Hospital Stroke Services.

PY - 2019/7/17

Y1 - 2019/7/17

N2 - Background: Relationship of estimated glomerular filtration rate (eGFR) with complications after stroke has not been fully characterized for entire clinical spectrum of eGFR and for the fluctuation in eGFR during hospital stay.Methods: Data from the Norfolk and Norwich Stroke Registry recorded between January 2003 and April 2015 was analysed. eGFR was categorized into six clinically relevant categories as per Kidney Disease Improving Global Outcomes guidelines. Change in eGFR during acute admission was categorized into: within 5% change (ref.), 5-20% decline, >20% decline, 5-20% increase and >20% increase. All-cause mortality, recurrent stroke, incident myocardial infarction, prolonged hospital stay and stroke disability at discharge were outcomes of interest.Results: 10,329 stroke patients (mean age 77.8 years) were followed for a mean of 2.9 years (30,126 person years). Multivariable adjusted hazard ratios (HRs) (95%CI) for all-cause mortality were 0.91 (0.80-1.04), 0.96 (0.83-1.11), 1.23 (1.06-1.43), 1.54 (1.31-1.82) and 2.38 (1.91-2.97) for eGFR levels 60-89, 45-59, 30-44, 15-29 and <15 respectively, compared to eGFR ≥90 mL/min/1.73m2. The HR (95%CI) for eGFR change were 1.56 (1.36-1.79), 1.17 (1.05-1.30), 1.47 (1.32-1.62) and 1.71 (1.55-1.88) for >20% decline, 5-20% decline, 5-20% increase and >20 % increase, respectively, compared to change within 5%. Results were similar for other outcomes except recurrent stroke.Conclusions: Stroke patients with eGFR <45 mL/min/1.73m2 at hospital admission and > 5% decline or increase in eGFR during hospital stay were at substantially high risk of poor outcomes, particularly all-cause mortality, myocardial infarction, prolonged hospital stay and disability at discharge.

AB - Background: Relationship of estimated glomerular filtration rate (eGFR) with complications after stroke has not been fully characterized for entire clinical spectrum of eGFR and for the fluctuation in eGFR during hospital stay.Methods: Data from the Norfolk and Norwich Stroke Registry recorded between January 2003 and April 2015 was analysed. eGFR was categorized into six clinically relevant categories as per Kidney Disease Improving Global Outcomes guidelines. Change in eGFR during acute admission was categorized into: within 5% change (ref.), 5-20% decline, >20% decline, 5-20% increase and >20% increase. All-cause mortality, recurrent stroke, incident myocardial infarction, prolonged hospital stay and stroke disability at discharge were outcomes of interest.Results: 10,329 stroke patients (mean age 77.8 years) were followed for a mean of 2.9 years (30,126 person years). Multivariable adjusted hazard ratios (HRs) (95%CI) for all-cause mortality were 0.91 (0.80-1.04), 0.96 (0.83-1.11), 1.23 (1.06-1.43), 1.54 (1.31-1.82) and 2.38 (1.91-2.97) for eGFR levels 60-89, 45-59, 30-44, 15-29 and <15 respectively, compared to eGFR ≥90 mL/min/1.73m2. The HR (95%CI) for eGFR change were 1.56 (1.36-1.79), 1.17 (1.05-1.30), 1.47 (1.32-1.62) and 1.71 (1.55-1.88) for >20% decline, 5-20% decline, 5-20% increase and >20 % increase, respectively, compared to change within 5%. Results were similar for other outcomes except recurrent stroke.Conclusions: Stroke patients with eGFR <45 mL/min/1.73m2 at hospital admission and > 5% decline or increase in eGFR during hospital stay were at substantially high risk of poor outcomes, particularly all-cause mortality, myocardial infarction, prolonged hospital stay and disability at discharge.

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KW - stroke

KW - prognosis

KW - mortality

KW - disability

KW - all-cause

KW - chronic kidney-disease

KW - EGFR

KW - MORTALITY

KW - ALL-CAUSE

KW - CHRONIC KIDNEY-DISEASE

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