IV thrombolysis and renal function

Gensicke, Henrik; Zinkstok, Sanne M.; Roos, Yvo B.; Seiffge, David J.; Ringleb, Peter; Artto, Ville; Putaala, Jukka; Haapaniemi, Elena; Leys, Didier; Bordet, Régis; Michel, Patrik; Odier, Céline; Berrouschot, Jörg; Arnold, Marcel; Heldner, Mirjam Rachel; Zini, Andrea; Bigliardi, Guido; Padjen, Visnja; Peters, Nils; Pezzini, Alessandro; ... (2013). IV thrombolysis and renal function. Neurology, 81(20), pp. 1780-1788. Lippincott Williams & Wilkins 10.1212/01.wnl.0000435550.83200.9e

[img]
Preview
Text
Gensike2013_Neurology.pdf - Published Version
Available under License Publisher holds Copyright.
If required by institutional policy, Publisher's version/PDF deposited available in PubMed Central may be deposited in institutional repository12 months embargo after publication

Download (337kB) | Preview

OBJECTIVE To investigate the association of renal impairment on functional outcome and complications in stroke patients treated with IV thrombolysis (IVT). METHODS In this observational study, we compared the estimated glomerular filtration rate (GFR) with poor 3-month outcome (modified Rankin Scale scores 3-6), death, and symptomatic intracranial hemorrhage (sICH) based on the criteria of the European Cooperative Acute Stroke Study II trial. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Patients without IVT treatment served as a comparison group. RESULTS Among 4,780 IVT-treated patients, 1,217 (25.5%) had a low GFR (<60 mL/min/1.73 m(2)). A GFR decrease by 10 mL/min/1.73 m(2) increased the risk of poor outcome (OR [95% CI]): (ORunadjusted 1.20 [1.17-1.24]; ORadjusted 1.05 [1.01-1.09]), death (ORunadjusted 1.33 [1.28-1.38]; ORadjusted 1.18 [1.11-1.249]), and sICH (ORunadjusted 1.15 [1.01-1.22]; ORadjusted 1.11 [1.04-1.20]). Low GFR was independently associated with poor 3-month outcome (ORadjusted 1.32 [1.10-1.58]), death (ORadjusted 1.73 [1.39-2.14]), and sICH (ORadjusted 1.64 [1.21-2.23]) compared with normal GFR (60-120 mL/min/1.73 m(2)). Low GFR (ORadjusted 1.64 [1.21-2.23]) and stroke severity (ORadjusted 1.05 [1.03-1.07]) independently determined sICH. Compared with patients who did not receive IVT, treatment with IVT in patients with low GFR was associated with poor outcome (ORadjusted 1.79 [1.41-2.25]), and with favorable outcome in those with normal GFR (ORadjusted 0.77 [0.63-0.94]). CONCLUSION Renal function significantly modified outcome and complication rates in IVT-treated stroke patients. Lower GFR might be a better risk indicator for sICH than age. A decrease of GFR by 10 mL/min/1.73 m(2) seems to have a similar impact on the risk of death or sICH as a 1-point-higher NIH Stroke Scale score measuring stroke severity.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Arnold, Marcel; Heldner, Mirjam Rachel and Sarikaya, Hakan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Valentina Rossetti

Date Deposited:

16 Jun 2014 07:53

Last Modified:

07 Aug 2017 08:31

Publisher DOI:

10.1212/01.wnl.0000435550.83200.9e

PubMed ID:

24122182

BORIS DOI:

10.7892/boris.53526

URI:

https://boris.unibe.ch/id/eprint/53526

Actions (login required)

Edit item Edit item
Provide Feedback