Long-Term Prognosis of Acute Kidney Injury after First Acute Stroke
Long-Term Prognosis of Acute Kidney Injury after First Acute Stroke
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DOI：
10.2215/cjn.04110808
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发表时间：
2009-03-01
影响因子：
9.8
通讯作者：
Vernmos, Konstantinos N.
中科院分区：
文献类型：
--
作者：
Tsagalis, George;Akrivos, Theodore;Vernmos, Konstantinos N.
背景和目的：急性肾损伤（AKI）在各种临床环境中与死亡率增加有关。我们研究了AKI的发生率、预测因素以及对卒中后长期总死亡率和心血管事件的影响。设计、设置、参与者和测量：这是一项对2155例急性首次卒中患者进行的前瞻性结果研究，随访10年。患者分为两组：(1)急性升高（超过48小时）血清肌酐>= 0.3 mg/dl或>百分比升高= 50%的患者；(2)变化< 0.3 mg/dl，根本没有变化，甚至降低的患者。结果：27%的患者在急性脑卒中后发生AKI。卒中严重程度、基线估计GFR、心力衰竭和卒中亚型可预测AKI的发生。AKI患者10年死亡率的概率为75.9，无AKI患者为57.7 （log rank检验45.0;P = 0.001）。当AKI患者根据AKI严重程度细分为三组时，10年死亡率的概率增加：第1、2和3期分别为73.7、86.5和89.2。在Cox比例风险分析中，AKI是10年死亡率（P < 0.01）和新的复合心血管事件发生的独立预测因子（P < 0.05）。结论：脑卒中后AKI是10年死亡率和新的复合心血管事件的一个强大且独立的预测因子。
Background and objectives: Acute kidney injury (AKI) has been associated with increased mortality in a variety of clinical settings. We studied the incidence, predictors, and effect of AKI on long-term overall mortality and cardiovascular events after stroke.Design, setting, participants, & measurements: This was a prospective outcome study of 2155 patients who sustained an acute first-ever stroke and were followed for 10 yr. Patients were divided in two groups: (1) Those with an acute increase (over 48 h) in serum creatinine >= 0.3 mg/dl or a percentage increase of >= 50% and (2) those with a change < 0.3 mg/dl, no change at all, or even a reduction.Results: Twenty-seven percent of patients developed AKI after acute stroke. Stroke severity, baseline estimated GFR, heart failure, and stroke subtype predict the occurrence of AKI. The probability of 10-yr mortality for patients with AKI was 75.9 and 57.7 in the patients without AKI (log rank test 45.0; P = 0.001). When patients with AKI were subdivided into three groups according to AKI severity, the probability of 10-yr mortality increased: 73.7, 86.5, and 89.2 in stages 1, 2, and 3, respectively. In Cox proportional hazard analysis, AKI was an independent predictor of 10-yr mortality (P < 0.01) and for the occurrence of new composite cardiovascular events (P < 0.05) after adjustment for available confounding variables.Conclusions: AKI after stroke is a powerful and independent predictor of 10-yr mortality and new composite cardiovascular events.