The Predictive Value Of Estimated Glomerular Filtration Rate On Outcome Of Patients With Mild Acute Ischemic Stroke After Intravenous Thrombolysis With Urokinase

ObjectiveIn recent years,the intravenous thrombolysis rate of acute ischemic stroke in China has been greatly improved.According to statistics,the proportion of mild acute ischemic stroke in acute ischemic stroke is about 46.4%,so thrombolytic therapy of mild acute ischemic stroke deserves attention.Compared with the high medical cost of rt-PA,low-income stroke patients with mild symptoms in less developed areas of China are more likely to accept intravenous thrombolytic therapy with urokinase.This study explored the predictive value of estimated glomerular filtration rate(eGFR)for clinical outcomes after intravenous thrombolysis with urokinase in patients with acute mild ischemic stroke.The purpose of this study was to find a method to evaluate the benefit risk ratio of urokinase in the treatment of acute mild stroke,and to guide the intravenous thrombolytic therapy of urokinase in primary hospitals.MethodsPatients who underwent urokinase intravenous thrombolysis for acute mild ischemic stroke in the stroke center of Linqing people’s Hospital of Shandong Province from June 2018 to December 2019 were collected continuously.According to whether eGFR was normal or not,it was divided into normal eGFR group(eGFR≥90ml·min-1·1.73m-2)and decreased eGFR group(eGFR<90m1·min-1·1.73m-2),Observe and compare the difference of outcome indicators between the two groups.Outcome measures included early neurological deterioration(END)at 24 hours and seven days after thrombolysis,poor functional prognosis(mRS≥2 points)at 90 days and symptomatic intracerebral hemorrhage(SICH).Univariate and multivariate logistic regression was used to analyze the relationship between eGFR and adverse clinical outcomes,and the OR value and 95%CI of eGFR were calculated.ResultsA total of 229 patients were included in this study.There were 153 cases with normal eGFR and 76 cases with decreased eGFR.Univariate analysis showed that compared with patients in normal eGFR group,the incidence of 24-hour END and 7-day END in the group with decreased eGFR was higher,and the proportion of poor prognosis at 90 days was higher.The decrease of eGFR was a risk factor for 24-hour END(OR=5.333,95%CI 2.279-12.482,P<0.001),7-day END(OR=3.000,95%CI 1.204-7.476,P=0.018),and poor functional prognosis at 90 days(OR=2.604,95%CI 1.400-4.844,P=0.03).After adjusting for the potential confounders National Institutes of Health Stroke Scale(NIHSS)score、TOAST Classification、CT signs before thrombolysis including obsolete cerebral infarction and leukoaraiosis,multivariate Logistic regression analysis showed that compared with patients in normal eGFR group,END at 24 hours in the decreased eGFR group[22.4%(19/76)and 5.9%(9/153),OR=3.291,95%CI 1.320～8.204,P=0.011]were higher.The difference is statistically significant.END at seven days[15.8%(12/76)and 5.9%(9/153),OR=1.540,95%CI 0.555-4.272,P=0.407],poor functional prognosis at 90 days[36.8%(28/76)and 18.3%(28/153),OR=1.568,95%CI 0.772-3.186,P=0.213]in the decreased eGFR group were higher.This difference is not statistically significant.ConclusionsThe decrease of eGFR may be a risk factor of 24-hour END,and was not associated with 7-day END and poor prognosis at 90 days.