Relation of baseline presence and severity of renal disease to long-term mortality in persons with known stroke

Ani, Chizobam; Ovbiagele, Bruce

doi:10.1016/j.jns.2009.09.020

Cited by 23 publications

(16 citation statements)

References 38 publications

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“…First, patients with COPD have associated comorbid conditions (17) that have been associated with increased mortality in stroke patients including depression ( 18, 19, 20), and kidney disease (21). Second, patients with stroke are at increased risk of dysphagia, aspiration, and pneumonia all of which are worsened by the COPD status (22), third patients with severe COPD are hypoxemic and hypercapnic at baseline which may increase their susceptibility to brain injury and increase their risk of death, finally COPD especially during exacerbation is associated with pulmonary inflammation which can lead to systemic inflammation and increased oxidative stress leading to unstable plaques and prothrombotic events all of which could be associated with higher stroke burden (23, 24)…”

Section: Discussionmentioning

confidence: 99%

Prevalence and influence of chronic obstructive pulmonary disease on stroke outcomes in hospitalized stroke patients

Lekoubou

Ovbiagele

2017

eNeurologicalSci

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BACKGROUND Chronic obstructive pulmonary disease (COPD) and stroke are important causes of death. COPD patients are at higher risk of cerebral hypoxia and aspiration. Yet, relatively little is known about the prevalence of COPD among stroke patients or its impact on outcomes after an index stroke. We assess the prevalence of COPD among hospitalized stroke patients in a nationally representative sample and examine the effect of COPD with mortality risk in the hospital after a stroke. METHODS Using the National Inpatient Sample, a nationally representative dataset of US hospital admissions between January 2004 and December 2009 (n=48,087,002), we assessed Crude and age-adjusted COPD prevalence among stroke patients and in-hospital mortality rates by COPD status. Independent associations of COPD with in-hospital mortality following stroke were evaluated using multivariable logistic regression. RESULTS 11.71% (95% CI: 11.48–11.94%) of all adult patients hospitalized for stroke had COPD. The crude and age-adjusted in-hospital mortality rates for these patients were 6.33% (95% CI: 6.14–6.53%) and 5.99% (95% CI: 4.05–7.94%), respectively. On multivariable analyses, COPD was modestly associated with overall stroke mortality (OR 1.03; 95% CI 1.01–1.06; p=0.018). The greater risks of mortality were seen among those with intracerebral hemorrhage (OR: 1.12; 95% CI 1.03–1.20; p=0.005) and ischemic stroke patients (OR 1.08; 95% CI 1.03–1.13, p=0.001). CONCLUSIONS 12% of hospitalized stroke patients have COPD. The presence of COPD is independently associated with higher odds of dying during stroke. Prospective studies are needed to identify any modifiable risk factors contributing to this deleterious relationship.

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Section: Discussionmentioning

confidence: 99%

Prevalence and influence of chronic obstructive pulmonary disease on stroke outcomes in hospitalized stroke patients

Lekoubou

Ovbiagele

2017

eNeurologicalSci

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“…Albuminuria and low estimated glomerular filtration rate (eGFR), the two most widely recognized indices of kidney dysfunction, have separately been linked to poorer outcomes after an index stroke [1], [2], [3], [4],[5]. However, studies assessing the relationship of these renal biomarkers to acute stroke outcomes have generally been focused on albuminuria or eGFR, only one stroke type (hemorrhagic or ischemic), and short-term outcomes [5],[6],[7],[8].…”

Section: Introductionmentioning

confidence: 99%

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

Huang

Lee

et al. 2013

PLoS ONE

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BackgroundThe comparative relationships of widely recognized biomarkers of renal injury with short-term and long-term outcomes among critically ill acute stroke patients are unknown. We evaluated the impact of baseline albuminuria [urine albumin-creatinine ratio (UACR)≥30 mg/g] or low estimated glomerular filtration rate (eGFR<60 ml/min per 1.73 m2) on stroke patients admitted to the intensive care unit (ICU).MethodsWe reviewed data on consecutive stroke patients admitted to a hospital ICU in Taiwan from September 2007 to August 2010 and followed-up for 1 year. Baseline UACR was categorized into <30 mg/g (normal), 30–299 mg/g (microalbuminuria), and ≥300 mg/g (macroalbuminuria), while eGFR was divided into ≥60, 45–59, and <45 ml/min per 1.73 m2. The outcome measure was death or disability at 3-month and 1-year after stroke onset, assessed by dichotomizing the modified Rankin Scale at 3–6 versus 0–2.ResultsOf 184 consecutive patients, 153 (83%) met study entry criteria. Mean age was 67.9 years and median admission NIHSS score was 16. Among the renal biomarkers, only macroalbuminuria was associated with poorer 3-month outcome (OR 8.44, 95% CI 1.38 to 51.74, P = 0.021) and 1-year outcome (OR 18.06, 95% CI 2.59 to 125.94, P = 0.003) after adjustment of relevant covariates. When ischemic and hemorrhagic stroke were analyzed separately, macroalbuminuria was associated with poorer 1-year outcome among ischemic (OR 17.10, 95% CI 1.04 to 280.07, P = 0.047) and hemorrhagic stroke patients (OR 1951.57, 95% CI 1.07 to 3561662.85, P = 0.048), respectively, after adjustment of relevant covariates and hematoma volume.ConclusionsPresence of macroalbuminuria indicates poor 3-month and 1-year outcomes among critically ill acute stroke patients.

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“…Indeed, several studies have shown that presence of CKD defined by a variety of indices and formulas confers greater stroke risk [2,3]. In addition, a diagnosis of renal insufficiency has been linked to poorer mediumterm and long-term outcomes following occurrence of an index stroke including increased all-cause mortality [4][5][6][7]. However, very little is known about the impact of CKD on in-hospital mortality after an index stroke [8].…”

Section: Introductionmentioning

confidence: 99%

Chronic kidney disease and risk of death during hospitalization for stroke

Ovbiagele

2011

Journal of the Neurological Sciences

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Relation of baseline presence and severity of renal disease to long-term mortality in persons with known stroke

Cited by 23 publications

References 38 publications

Prevalence and influence of chronic obstructive pulmonary disease on stroke outcomes in hospitalized stroke patients

Prevalence and influence of chronic obstructive pulmonary disease on stroke outcomes in hospitalized stroke patients

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

Chronic kidney disease and risk of death during hospitalization for stroke

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