Association of Renal Biomarkers with 3-Month and 1-Year Outcomes among Critically Ill Acute Stroke Patients.docVIP

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Association of Renal Biomarkers with 3-Month and 1-Year Outcomes among Critically Ill Acute Stroke Patients.doc

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Association of Renal Biomarkers with 3-Month and 1-Year Outcomes among Critically Ill Acute Stroke Patients

AssociationofRenalBiomarkerswith3-Monthand1-Year OutcomesamongCriticallyIllAcuteStrokePatients Ying-ChihHuang1,Yi-LingWu1,Ming-HsuehLee2,Jiann-DerLee1,Chih-YingWu1,Huan-LinHsu1 ,Ya- HuiLin1,Yen-ChuHuang1,Wen-HungHuang3,Hsu-HueiWeng4,Jen-TsungYang2,MengLee1*, BruceOvbiagele5 1DepartmentofNeurology,ChangGungUniversityCollegeofMedicine,ChangGungMemorialHospital,Chiayi,Taiwan,2DepartmentofNeurosurgery,ChangGung UniversityCollegeofMedicine,ChangGungMemorialHospital,Chiayi,Taiwan,3DepartmentofNephrology,ChangGungUniversityCollegeofMedicine,ChangGung MemorialHospital,Linkou,Taiwan,4DepartmentofDiagnosticRadiology,ChangGungUniversityCollegeofMedicine,ChangGungMemorialHospital,Chiayi,Taiwan, 5DepartmentofNeurosciences,MedicalUniversityofSouthCarolina,Charleston,SouthCarolina,UnitedStatesofAmerica Abstract Background:Thecomparativerelationshipsofwidelyrecognizedbiomarkersofrenalinjurywithshort-termandlong-term outcomesamongcriticallyillacutestrokepatientsareunknown.Weevaluatedtheimpactofbaselinealbuminuria[urine albumin-creatinineratio(UACR)$30mg/g]orlowestimatedglomerularfiltrationrate(eGFR,60ml/minper1.73m2 )on strokepatientsadmittedtotheintensivecareunit(ICU). Methods:WerevieweddataonconsecutivestrokepatientsadmittedtoahospitalICUinTaiwanfromSeptember2007to August 2010 and followed-up for 1 year. Baseline UACR was categorized into ,30mg/g (normal), 30–299mg/g (microalbuminuria), and $300mg/g (macroalbuminuria), while eGFR was divided into $60, 45–59, and ,45ml/min per 1.73m2.Theoutcomemeasurewasdeathordisabilityat3-monthand1-yearafterstrokeonset,assessedbydichotomizing themodifiedRankinScaleat3–6versus0–2. Results:Of184consecutivepatients,153(83%)metstudyentrycriteria.Meanagewas67.9yearsandmedianadmission NIHSSscorewas16.Amongtherenalbiomarkers,onlymacroalbuminuriawasassociatedwithpoorer3-monthoutcome (OR8.44,95%CI1.38to51.74,P=0.021)and1-yearoutcome(OR18.06,95%CI2.59to125.94,P=0.003)afteradjustmentof relevant covariates. When ischemic and hemorrhagic stroke were analyz