TY - JOUR
T1 - Renal function and risk stratification of patients with embolic stroke of undetermined source
AU - Ntaios, George
AU - Lip, Gregory Y.H.
AU - Lambrou, Dimitris
AU - Michel, Patrik
AU - Perlepe, Kalliopi
AU - Eskandari, Ashraf
AU - Nannoni, Stefania
AU - Sirimarco, Gaia
AU - Strambo, Davide
AU - Vemmos, Konstantinos
AU - Koroboki, Eleni
AU - Manios, Efstathios
AU - Vemmou, Anastasia
AU - Rodríguez-Campello, Ana
AU - Cuadrado-Godia, Elisa
AU - Roquer, Jaume
AU - Arnao, Valentina
AU - Caso, Valeria
AU - Paciaroni, Maurizio
AU - Diez-Tejedor, Exuperio
AU - Fuentes, Blanca
AU - Pardo, Jorge Rodríguez
AU - Arauz, Antonio
AU - Ameriso, Sebastian F.
AU - Pertierra, Lucía
AU - Gómez-Schneider, Maia
AU - Hawkes, Maximiliano A.
AU - Bandini, Fabio
AU - Cano, Beatriz Chavarria
AU - Mohedano, Ana Maria Iglesias
AU - Pastor, Andrés García
AU - Gil-Núñez, Antonio
AU - Putaala, Jukka
AU - Tatlisumak, Turgut
AU - Barboza, Miguel A.
AU - Karagkiozi, Efstathia
AU - Makaritsis, Konstantinos
AU - Papavasileiou, Vasileios
N1 - Publisher Copyright:
© 2018 American Heart Association, Inc.
PY - 2018
Y1 - 2018
N2 - Background and Purpose-We aimed to assess if renal function can aid in risk stratification for ischemic stroke or transient ischemic attack (TIA) recurrence and death in patients with embolic stroke of undetermined source (ESUS). Methods-We pooled 12 ESUS datasets from Europe and America. Renal function was evaluated using the estimated glomerular filtration rate (eGFR) and analyzed in continuous, binary, and categorical way. Cox-regression analyses assessed if renal function was independently associated with the risk for ischemic stroke/TIA recurrence and death. The Kaplan-Meier product limit method estimated the cumulative probability of ischemic stroke/TIA recurrence and death. Results-In 1530 patients with ESUS followed for 3260 patient-years, there were 237 recurrences (15.9%) and 201 deaths (13.4%), corresponding to 7.3 ischemic stroke/TIA recurrences and 5.6 deaths per 100 patient-years, respectively. Renal function was not associated with the risk for ischemic stroke/TIA recurrence when forced into the final multivariate model, regardless if it was analyzed as continuous (hazard ratio, 1.00; 95% CI, 0.99.1.00 for every 1 mL/min), binary (hazard ratio, 1.27; 95% CI, 0.87. 1.73) or categorical covariate (likelihood-ratio test 2.59, P=0.63 for stroke recurrence). The probability of ischemic stroke/TIA recurrence across stages of renal function was 11.9% for eGFR ≥90, 16.6% for eGFR 60.89, 21.7% for eGFR 45.59, 19.2% for eGFR 30.44, and 24.9% for eGFR <30 (likelihood-ratio test 2.59, P=0.63). The results were similar for the outcome of death. Conclusions-The present study is the largest pooled individual patient-level ESUS dataset, and does not provide evidence that renal function can be used to stratify the risk of ischemic stroke/TIA recurrence or death in patients with ESUS.
AB - Background and Purpose-We aimed to assess if renal function can aid in risk stratification for ischemic stroke or transient ischemic attack (TIA) recurrence and death in patients with embolic stroke of undetermined source (ESUS). Methods-We pooled 12 ESUS datasets from Europe and America. Renal function was evaluated using the estimated glomerular filtration rate (eGFR) and analyzed in continuous, binary, and categorical way. Cox-regression analyses assessed if renal function was independently associated with the risk for ischemic stroke/TIA recurrence and death. The Kaplan-Meier product limit method estimated the cumulative probability of ischemic stroke/TIA recurrence and death. Results-In 1530 patients with ESUS followed for 3260 patient-years, there were 237 recurrences (15.9%) and 201 deaths (13.4%), corresponding to 7.3 ischemic stroke/TIA recurrences and 5.6 deaths per 100 patient-years, respectively. Renal function was not associated with the risk for ischemic stroke/TIA recurrence when forced into the final multivariate model, regardless if it was analyzed as continuous (hazard ratio, 1.00; 95% CI, 0.99.1.00 for every 1 mL/min), binary (hazard ratio, 1.27; 95% CI, 0.87. 1.73) or categorical covariate (likelihood-ratio test 2.59, P=0.63 for stroke recurrence). The probability of ischemic stroke/TIA recurrence across stages of renal function was 11.9% for eGFR ≥90, 16.6% for eGFR 60.89, 21.7% for eGFR 45.59, 19.2% for eGFR 30.44, and 24.9% for eGFR <30 (likelihood-ratio test 2.59, P=0.63). The results were similar for the outcome of death. Conclusions-The present study is the largest pooled individual patient-level ESUS dataset, and does not provide evidence that renal function can be used to stratify the risk of ischemic stroke/TIA recurrence or death in patients with ESUS.
KW - Brain ischemia
KW - Glomerular filtration rate
KW - Probability
KW - Recurrence
KW - Stroke
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U2 - 10.1161/STROKEAHA.118.023281
DO - 10.1161/STROKEAHA.118.023281
M3 - Article
C2 - 30571398
AN - SCOPUS:85058916569
SN - 0039-2499
VL - 49
SP - 2904
EP - 2909
JO - Stroke
JF - Stroke
IS - 12
ER -