Newer glomerular filtration rate estimating equations for the full age spectrum based on serum creatinine and cystatin C in predicting mortality in patients with ischemic stroke
Newer glomerular filtration rate estimating equations for the full age spectrum based on serum creatinine and cystatin C in predicting mortality in patients with ischemic stroke
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DOI：
10.1016/j.ejim.2018.02.005
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发表时间：
2018-06-01
影响因子：
8
通讯作者：
Hojs, Radovan
中科院分区：
文献类型：
--
作者：
Fabjan, Tanja Hojs;Penko, Meta;Hojs, Radovan
背景：肾功能不全与死亡风险增加有关。基于血清肌酐（FAScrea）和胱抑素C （FAScysC）估算肾小球滤过率（GFR）的新型全年龄谱（FAS）方程在整个年龄谱中得到验证，与其他方程相比，它是肾功能的卓越标记。这些方程与缺血性脑卒中患者死亡率的可能关联尚不清楚。患者和方法：我们在我们的观察性队列研究中纳入了390例患有缺血性卒中的患者（207例男性，183例女性），随访3年。入院时测定血清肌酐和胱抑素C；根据FAScrea、CKD-EPlcrea、FAScysC和CKD-EPIcysC方程估计GFR。估计的gfr值被分成五分位数。结果：随访期间死亡173例（44.4%）。FAScrea和CKD-EPlcrea与全因死亡率的风险比呈j型关系，只有在第5个五分位数与第1个五分位数的死亡率风险比比较时才显著升高（P < 0.001）。对于FAScysC和CKD-EPIcysC，风险比从第一到第五分位数呈线性增加。在一项校正分析中，FAScrea和ckd - epplcrea与全因死亡率无关，与第一个五分位数相比，FAScrea和ckd - epplcrea的第五分位数的风险比（P = 0.008）和ckd - epplcrea的风险比（P = 0.042）与死亡率显著相关。结论：在缺血性卒中患者中，基于血清胱抑素（FAScysC和ckysc）估计的GFR比基于血清肌酐估计的GFR更能预测全因死亡率和心血管死亡率。
Background: Renal dysfunction is associated with increased risk of mortality. The novel Full Age Spectrum (FAS) equations estimating the glomerular filtration rate (GFR) based on serum creatinine (FAScrea) and cystatin C (FAScysC) are validated across the entire age spectrum and are superior markers of renal function compared to other equations. Possible association of these equations with mortality in patients with ischemic stroke is not known.Patients and methods: We included 390 patients (207 men, 183 women) in our observational cohort study who had suffered from an ischemic stroke and followed-up on for 3 years. Serum creatinine and cystatin C were measured at admission; GFR was estimated according to the FAScrea, CKD-EPlcrea, FAScysC and CKD-EPIcysC equations. The values of estimated GFRs were divided into quintiles.Results: During the follow-up period, 173 (44.4%) patients died. The association of hazard ratios for FAScrea and CKD-EPlcrea with all-cause mortality was J-shaped and only significantly higher when comparing the fifth quintile hazard ratio for mortality with the first quintile (P < 0.001). For FAScysC and CKD-EPIcysC, hazard ratios increased from the first to the fifth quintile linearly. In an adjusted analysis, FAScrea and CKD-EPlcrea were not associated with all-cause mortality and the hazard ratios of the fifth quintile of FAScysC (P = 0.008) and CKD-EPIcysC (P = 0.042) were significantly associated with mortality compared to the first quintile.Conclusions: In patients with an ischemic stroke, estimated GFR based on serum cystatin (FAScysC and CKDEPIcysC) was a better predictor of all-cause and cardiovascular mortality than estimated GFR based on serum creatinine.