Analysis Of Clinical Characteristics And Prognostic Factors In Patients With CKD Stage 3-5 Complicated With Hemorrhagic Stroke

Objecti ve:To collect the clinical data of patients with CKD stage 3-5 combined hemorrhagic stroke,understand the prognosis of patients,and analyze the differences in general information,laboratory indicators,TCM syndrome,etc.of patients with different prognosis of CKD stage 3-5 combined hemorrhagic stroke,and the prognosis correlation,to explore their accuracy to predict the prognosis of patients with CKD stage 3-5 with hemorrhagic stroke.Methods:This study adopted a retrospective research method,taking CKD stage 3-5 patients with hemorrhagic stroke as the research object,collecting general information,basic medical history,related laboratory indicators,TCM syndromes and other clinical data.Statistical analysis was performed using SPSS18.0 statistical software to compare the clinical data of patients with CKD complicated with hemorrhagic stroke in different stages,and to explore the prognostic factors of patients with CKD stage 3-5 combined hemorrhagic stroke.Result:1.After retrieval and progressive screening,a total of 128 patients with CKD stage 3-5 with hemorrhagic stroke were included.①General information:94 males(73.4%)and 34 females(26.6%);The average age was(63.89±17.00)years;The average length of hospital stay(13.34±10.06)days;②Bleeding sites:mainly Basal ganglia(44.5%),followed by Cerebral lobes(21.9%),Thalamus(19.5%),Brain stem(7.0%),Cerebellum(3.1%),Others(3.9%);③Bleeding volume:a small amount(<10ml),a medium amount(10-30ml),a large amount(>30ml)accounted for 38.3%,25.8%,and 35.9%,respectively;④Chinese medicine:54 cases(42.2%)withattack on meridians and 74 cases(57.8%)with attack on viscera;TCM syndromes:From most to least:Fire heat syndrome,Wind syndrome,Yin Deficiency and Yang Excess Syndrome,Blood stasis syndrome,Phlegm syndrome,Qi deficiency syndrome;⑤ Kidney replacement Treatment:A total of 25 cases,accounting for 19.5%,4 cases of CRRT(3.1%),16 cases of heparin-free dialysis(12.5%),and 6 cases of peritoneal dialysis(4.7%).2.Divided into three groups according to different stages of CKD,namely CKD stage 3,4 and 5,the statistical results are as follows:80 cases(62.5%)of CKD stage 3,15 cases(11.7%)of CKD stage 4,33 cases(25.8%)of CKD stage 5;① In terms of general information,Men with CKD3 stage have a higher proportion than men with CKD5 stage(P<0.05);②Laboratory test results,Hemoglobin(Hb),Platelet(PLT),Lymphocyte count(LYM),Neutrophil count(NEUT),Red blood cell distribution width(RDW),Blood potassium(K+),Blood sodium(Na+),and Blood calcium(Ca2+)levels were different between the three groups(P<0.05);The pairwise comparison within the group,CKD3,CKD5 Phase comparison:Hb,PLT,LYM,NEUT,Na+,and Ca2+in CKD3 stage is higher than that in CKD5 stage(P<0.05),CKD3 stage was significantly lower than CKD5 stagein K+(P<0.001);CKD4,5 stage compared:Na+ in CKD4 stage was significantly higher than CKD5 stage(P<0.05),K+in CKD4 stage was significantly lower than CKD5 stage(P<0.05);Hb levels in patients with CKD3 stage were higher than CKD4 stage;③ The characteristics of cerebral hemorrhage(Bleeding site,Amount of bleeding)were not significantly different between the three groups(P>0.05).3.Divided into two groups according to the prognosis of patients:good prognosis group,poor prognosis group.Among them,there are a maximum of 77 cases(60.2%)in the poor prognosis group,of which 40 died(in-hospital/3 months after discharge),and 51 cases(39.8%)with good prognosis group.Two groups of comparison results:① Univariate analysis results showed admission GCS score,Bleeding volume,Stroke category,Fiery syndrome,White blood cell count(WBC),NEUT,LYM,Platelet and Lymphocyte ratio(PLR),The Neutrophil and Lymphocyte ratio(NLR),Blood lactic acid(Lac),Blood glucose,estimated glomerular filtration rate(eGFR),Blood creatinine(SCr),and Na+ were significantly different between the two groups.(P<0.05);② Multivariate analysis showed GCS scores(OR:0.748,95%CI:0.623-0.897),Blood loss(OR:5.431,95%CI:2.168-13.601),NLR(OR:1.113,95%CI:1.032-1.199),suggesting that a high GCS score on admission is a protective factor for the poor prognosis of CKD stage 3-5 combined hemorrhagic stroke;Bleeding volume and NLR levels are independent risk factors for poor prognosis of CKD stage 3-5 combined hemorrhagic stroke(P<0.05);③Results of receiver operating characteristic curve(ROC curve)GCS score on admission,NLR area under the curve[AUC(95%CI)]were 0.873(0.810-0.935),0.798(0.716-0.879).Conclusions:1.Patients with CKD stage 3-5 combined with hemorrhagic stroke are more male than female in each stage of CKD;The levels of Hb,PLT,LYM,NEUT,K+,Na+ and Ca2+ are different in different CKD stages;the main cerebral hemorrhage site is Basal ganglia,followed by the brain lobe and thalamus;In terms of stroke syndromes,there are the most hot and wind syndromes,followed by yin deficiency and yang Hyperactivity syndrome,blood stasis syndrome,sputum syndrome,Qi deficiency syndrome are the least;2.Admission GCS score,bleeding volume,stroke type,heat syndrome,WBC,NEUT,LYM,PLR,NLR,blood sugar,Lac,SCr,eGFR,Na+ and the prognosis of these patients may be relevant;3.A low admission GCS score,a large amount of bleeding,and a high level of NLR may be independent risk factors that affect the prognosis of patients with CKD stage 3-5 combined with hemorrhagic stroke;4.According to the area under the ROC curve,the admission GCS score and NLR may be independent predictors of the prognosis of patients with CKD stage 3-5 combined hemorrhagic stroke.The sensitivity of the admission GCS score to the prognosis of the two groups of patients is better than the NLR level.