Abstract 2938: Decreased Glomerular Filtration Rate Has A Greater Impact On The Outcome In Hemorrhagic Stroke Than In Ischemic Stroke In Acute Stage.

Abstract

Background and Purpose- Recently, chronic kidney disease: CKD has been focused on the stroke, and decreased glomerular filtration rate (GFR) is reported to be a risk factor for stroke. However, little is known about the difference of impact on the outcome between ischemic stroke and hemorrhagic stroke in acute stage. Here we analyzed the impact of an estimated GFR on prognosis in relation to stroke type. Methods- Between July 2007 to July 2010, 433 consecutive patients with acute stroke in our institute were retrospectively analyzed. (Ischemic stroke: N=270, Hemorrhagic stroke: N=163). Estimated GFR (eGFR) was calculated according to the abbreviated modification of diet in renal disease formula in all patients. CKD was categorized by the estimated GFR into severe CKD group (<30), moderate/mild CKD group (30-60) and no CKD group (>60 ml/min/1.73 mm 2 ). Patients characteristics, the location and volume of the lesion were analyzed.To examine the relationship between CKD and the outcome assessed with in-hospital mortality and National Institute of Health Stroke Scale (NIHSS), multivariable analyses were conducted. Results- In severe and moderate/mild CKD groups, patients with ischemic stroke had a higher age and a lower baseline NIHSS compared to patients with hemorrhagic stroke. (p=0.0001) Among both ischemic and hemorrhagic stroke, groups with poorer eGFR had a significantly higher mortality than groups with better eGFR. (Hemorrhagic stroke: 38%, 14.2% and 5.5% p<0.0001, Ischemic stroke: 15%, 11.1% and 2.2% p<0.0001) A rate of lesion volume expansion after admission was higher in hemorrhagic stroke than in ischemic stroke. (p=0.001) In multivariate analysis, we found a significant stronger correlation between decreased eGFR and in-hospital mortality, a rate of lesion volume expansion in hemorrhagic stroke than in ischemic stroke. Discussion and Conclusions- Decreased glomerular filtration rate have a greater impact on the outcome of hemorrhagic stroke than that of ischemic stroke in acute stage. The expansion of the lesion volume might contribute to this result.