한빛사 논문
Hyungjong Park 1, Young Dae Kim 2, Hyo Suk Nam 2, Joonsang Yoo 3, Sung-Il Sohn 1, Jeong-Ho Hong 1, Byung Moon Kim 4, Dong Joon Kim 4, Oh Young Bang 5, Woo-Keun Seo 5, Jong-Won Chung 5, Kyung-Yul Lee 6, Yo Han Jung 6, Hye Sun Lee 7, Seong Hwan Ahn 8, Dong Hoon Shin 9, Hye-Yeon Choi 10, Han-Jin Cho 11, Jang-Hyun Baek 12, Gyu Sik Kim 13, Kwon-Duk Seo 13, Seo Hyun Kim 14, Tae-Jin Song 15, Jinkwon Kim 3, Sang Won Han 16, Joong Hyun Park 16, Suk Ik Lee 17, Joon Nyung Heo 2, Hyung Woo Lee 2, Il Hyung Lee 2, Minyoul Baik 2, Ji Hoe Heo 2, SECRET Study Investigators
1Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea (H.P., S.-I.S., J.-H.H.).
2Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.(Y.D.K., H.S.N., J.N.H., H.W.L., I.H.L., M.B., J.H.H.).
3Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. (J.Y., J.K.).
4Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea. (B.M.K., D.J.K.).
5Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. (O.Y.B., W.-K.S., J.-W.C.).
6Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea (K.Y.L., Y.H.J.).
7Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea. (H.S.L.).
8Department of Neurology, Chosun University School of Medicine, Gwangju, South Korea (S.H.A.).
9Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea (D.H.S.).
10Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, South Korea (H.-Y.C.).
11Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea (H.-J.C.).
12Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. (J.-H.B.).
13Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea (G.S.K., K.-D.S.).
14Department of Neurology, Yonsei University Wonju College of Medicine, South Korea (S.H.K.).
15Department of Neurology, Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea (T.-J.S.).
16Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea (S.W.H., J.H.P.).
17Department of Neurology, Sanbon Hospital, Wonkwang University School of Medicine, Sanbon, South Korea (S.I.L.).
Correspondence to: Young Dae Kim, MD, PhD
Abstract
Background: A high and low estimated glomerular filtration rate (eGFR) could affect outcomes after reperfusion therapy for ischemic stroke. This study aimed to determine whether renal function based on eGFR affects mortality risk in patients with ischemic stroke within 6 months following reperfusion therapy.
Methods: This prospective registry-based cohort study included 2266 patients who received reperfusion therapy between January 2000 and September 2019 and were registered in the SECRET (Selection Criteria in Endovascular Thrombectomy and Thrombolytic Therapy) study or the Yonsei Stroke Cohort. A high and low eGFR were based on the Chronic Kidney Disease Epidemiology Collaboration equation and defined, respectively, as the 5th and 95th percentiles of age- and sex-specific eGFR. Occurrence of death within 6 months was compared among the groups according to their eGFR such as low, normal, or high eGFR.
Results: Of the 2266 patients, 2051 (90.5%) had a normal eGFR, 110 (4.9%) a low eGFR, and 105 (4.6%) a high eGFR. Patients with high eGFR were younger or less likely to have hypertension, diabetes, or atrial fibrillation than the other groups. Active cancer was more prevalent in the high-eGFR group. During the 6-month follow-up, there were 24 deaths (22.9%) in the high-eGFR group, 37 (33.6%) in the low-eGFR group, and 237 (11.6%) in the normal-eGFR group. After adjusting for variables with P<0.10 in the univariable analysis, 6-month mortality was independently associated with high eGFR (hazard ratio, 2.22 [95% CI, 1.36-3.62]; P=0.001) and low eGFR (HR, 2.29 [95% CI, 1.41-3.72]; P=0.001). These associations persisted regardless of treatment modality or various baseline characteristics.
Conclusions: High eGFR as well as low eGFR were independently associated with 6-month mortality after reperfusion therapy. Kidney function could be considered a prognostic factor in patients with ischemic stroke after reperfusion therapy.
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