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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Chronic Kidney Disease and Outcome Following Endovascular Thrombectomy for Acute Ischemic Stroke
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Chronic Kidney Disease and Outcome Following Endovascular Thrombectomy for Acute Ischemic Stroke

机译：急性缺血性卒中血管内血栓切除术后慢性肾病和结果

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Background and Objectives: Chronic kidney disease (CKD) is present in 20% to 35% of acute ischemic stroke patients and may increase the risk of poor functional outcome or death. We aimed to determine whether CKD was associated with worse outcome in stroke patients treated with endovascular thrombectomy (EVT). Design, Setting, Participants, and Measurements: Consecutive EVT patients were identified from a prospective registry and dichotomized into patients with and without CKD, defined as an eGFR of less than 60 mL/min/1.73m(2). The primary outcome was 3-month mortality following EVT. Secondary outcomes included symptomatic intracerebral hemorrhage (defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study), early neurological recovery (defined as change in National Institutes of Health Stroke Scale [NIHSS] score of >= 8 at 24 hours or an NIHSS of 0-1 at 24 hours) and functional independence (defined as a modified Rankin Scale [mRS] score of 0, 1 or 2) at 3 months. Results: 378 EVT patients (223 men; mean +/- SD age 65 +/- 15 years) were included. The median (IQR) admission eGFR was 71 (58-89) mL/min/ 1.73 m(2) and 117 (31%) patients had CKD. Multiple logistic regression adjusted for potential confounders demonstrated that CKD was a significant predictor of lower rates of functional independence (OR = .54, 95% CI, .31 to .90, P = .02), higher mRS scores (common OR = 1.78, 95% CI, 1.14 to 2.81, P = .01), and increased mortality (OR = 2.19, 95% CI, 1.16 to 4.12, P = .01). There was no association between CKD and early neurological recovery (OR = .92, 95% CI, .55 to 1.49, P = .71) or symptomatic intracerebral hemorrhage (OR = 1.18, 95% CI, .38 to 3.69, P = .77). Conclusions: CKD was a significant predictor of worse functional outcome and mortality in stroke patients treated with EVT. The presence of CKD should not preclude patients from proceeding to EVT, but may help with prognostication and improve shared decision-making between patients, families and physicians.
机译：背景和目的：20%至35%的急性缺血性卒中患者存在慢性肾脏疾病（CKD），可能增加功能不良或死亡的风险。我们的目的是确定在接受血管内血栓切除术（EVT）治疗的中风患者中，CKD是否与更差的预后相关。设计、设置、参与者和测量：从前瞻性登记中确定连续EVT患者，并将其分为伴有和不伴有CKD的患者，定义为eGFR小于60 mL/min/1.73m（2）。主要结果是EVT后3个月的死亡率。次要转归包括症状性脑出血（根据卒中监测研究中溶栓的安全实施进行定义），早期神经功能恢复（定义为美国国立卫生研究院卒中量表[NIHSS]评分在24小时时变化>=8或NIHSS在24小时时变化为0-1）和功能独立性（定义为改良的Rankin量表[mRS]评分为0、1或2）在3个月时。结果：纳入378例EVT患者（223名男性；平均+/-SD年龄65+/-15岁）。入院eGFR的中位数（IQR）为71（58-89）mL/min/1.73 m（2），117（31%）名患者患有CKD。经潜在混杂因素校正的多元逻辑回归显示，CKD是功能独立性降低（OR=0.54，95%CI，.31-0.90，P=0.02）、mRS评分升高（常见OR=1.78，95%CI，1.14-2.81，P=0.01）和死亡率增加（OR=2.19，95%CI，1.16-4.12，P=0.01）的显著预测因子。CKD与早期神经功能恢复（OR=0.92，95%CI，.55至1.49，P=0.71）或症状性脑出血（OR=1.18，95%CI，.38至3.69，P=0.77）之间没有相关性。结论：CKD是EVT治疗的卒中患者更差的功能预后和死亡率的重要预测因子。CKD的存在不应妨碍患者进行EVT，但可能有助于预测，并改善患者、家属和医生之间的共同决策。

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