Effect Of Estimated Glomerular Filtration Rate In Outcome Of Patients With Acute Ischemic Stroke Treated With Intravenous Alteplase Thrombolysis

Objective To explore the association between estimated glomerular filtration rate（e GFR）and prognosis of acute ischemic stroke（AIS）patients who were treated by intravenous thrombolysis with alteplase.Methods Consecutively screened AIS patients who were treated by intravenous thrombolysis with alteplase from January 2006 to September 2016 in Tangshan Gongren Hospital.In the present study,according to e GFR value of patients at admission,firstly,the eligible patients were divided into two groups,namely,“normal e GFR group”(e GFR≥90 m L·min^-1·1.73m^-2)and “decreased e GFR group”(e GFR<90 m L·min^-1·1.73m^-2).Then the eligible patients were divided into three groups(≥90 ml·min^-1·1.73m^-2,60^&lt;90 ml·min^-1·1.73m^-2,<60 ml·min^-1·1.73m^-2)according to e GFR value of patients.The incidence of symptomatic intracranial hemorrhage（s ICH）,early neurological deterioration（END）at 24 hours and 7 days after thrombolysis,mortality within 7 days and 90 days,and excellent recovery at 90 days were compared between the two groups.The odds ratios（OR）with 95% confidence intervals（CI）and the adjusted ORs with 95% CIs were analyzed by univariate and multivariate Logistic regression models.Results A total of 258 patients were enrolled,including 182 cases in normal e GFR group and 76 cases in decreased e GFR group.After adjusting the potential confounders,multivariate logistic regression analysis showed that the rates of s ICH [13.2%（10/76）vs 3.3%（6/182）respectively,OR=3.859,95% CI=1.313¹1.341,P=0.014],END at 24 hours [21.1%（16/76）vs 8.2%（15/182）respectively,OR=2.958,95% CI=1.347⁶.495,P=0.007] and 7 days [32.9%（25/76）vs 12.6%（23/182）respectively,OR=3.129,95% CI=1.555⁶.293,P=0.001],death within 7 days [22.4%（17/76）vs 6.0%（11/182）respectively,OR=4.079,95% CI=1.588¹0.477,P=0.003] and 90 days [23.7%（18/76）vs 9.9%（18/182）respectively,OR=2.457,95% CI=1.050⁵.749,P=0.038] were higher in decreased e GFR group than in normal e GFR group.On the other hand,the chance of excellent recovery at 90 days was less in decreased e GFR group than in normal e GFR group [22.4%（17/76）vs 43.4%（79/182）respectively,OR=0.435,95% CI=0.229⁰.824,P=0.011].In the stratified study,a total of 182 patients with e GFR greater than 90 ml·min^-1·1.73m^-2,57 patients with e GFR of 60^&lt;90 ml·min^-1·1.73m^-2,and 19 patients with e GFR<60 ml·min^-1·1.73m^-2.The risk of s ICH,END and death were trending to increase as the e GFR was decreased,and the chance of excellent recovery at 90 days was decreased.Conclusions Decreased e GFR may not only increase the risks of s ICH,END and death,but also reduce the chance of 90-day excellent recovery in AIS patients after intravenous thrombolysis with alteplase.