Does renal dysfunction modify the effect of intravenous thrombolysis for acute ischemic stroke within 4.5 hours of onset? A multicenter observational study

Cheng Yang Hsieh, Huey Juan Lin, Sheng Feng Sung, Yea Huei Kao Yang, Edward Chia Cheng Lai, Han Chieh Hsieh, Chih Hung Chen

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background About one third of stroke patients have renal dysfunction. Effect of renal dysfunction on outcome of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) has not been determined in Asia using patients without IVT as comparators. The aim of this study was to examine the interaction between renal dysfunction and IVT on the outcomes in AIS patients admitted within 4.5 hours of onset in a multicenter stroke registry of Taiwan. Methods We identified all consecutive AIS patients admitted within 4.5 hours of onset between 2007 and 2013. Renal dysfunction was defined by an estimated glomerular filtration rate less than 60 mL/minute/1.73 m2 on initial admission. Patients older than 80 years of age and a National Institute of Health Stroke Scale score less than 4 or greater than 25 were excluded. The primary outcome was a modified Rankin Scale score 3-6 at 3 months. We determined the effect of IVT and renal dysfunction on outcome in a multivariate analysis. Results Of the 929 patients analyzed, 39% had renal dysfunction, and 51% received IVT. Primary outcomes occurred in 45% versus 41% of patients with and without renal dysfunction, respectively, (P =.197). In a multivariate analysis, the odds ratios (95% confidence interval; P value) of IVT and renal dysfunction for primary outcome were.70 (.51-.96; P =.029) and.97 (.71-1.33; P =.865), respectively. No significant interaction was noted between IVT and renal dysfunction (P =.218). Conclusions Renal dysfunction did not modify the effect of IVT for AIS and should not be a reason for withholding treatment from otherwise-eligible patients.

Original languageEnglish
Pages (from-to)673-679
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume24
Issue number3
DOIs
Publication statusPublished - 2015 Mar 1

Fingerprint

Multicenter Studies
Observational Studies
Stroke
Kidney
Multivariate Analysis
Withholding Treatment
National Institutes of Health (U.S.)
Glomerular Filtration Rate
Taiwan
Registries
Odds Ratio
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

@article{e3d8202c48b84bf89e51ddb2747c91c2,
title = "Does renal dysfunction modify the effect of intravenous thrombolysis for acute ischemic stroke within 4.5 hours of onset? A multicenter observational study",
abstract = "Background About one third of stroke patients have renal dysfunction. Effect of renal dysfunction on outcome of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) has not been determined in Asia using patients without IVT as comparators. The aim of this study was to examine the interaction between renal dysfunction and IVT on the outcomes in AIS patients admitted within 4.5 hours of onset in a multicenter stroke registry of Taiwan. Methods We identified all consecutive AIS patients admitted within 4.5 hours of onset between 2007 and 2013. Renal dysfunction was defined by an estimated glomerular filtration rate less than 60 mL/minute/1.73 m2 on initial admission. Patients older than 80 years of age and a National Institute of Health Stroke Scale score less than 4 or greater than 25 were excluded. The primary outcome was a modified Rankin Scale score 3-6 at 3 months. We determined the effect of IVT and renal dysfunction on outcome in a multivariate analysis. Results Of the 929 patients analyzed, 39{\%} had renal dysfunction, and 51{\%} received IVT. Primary outcomes occurred in 45{\%} versus 41{\%} of patients with and without renal dysfunction, respectively, (P =.197). In a multivariate analysis, the odds ratios (95{\%} confidence interval; P value) of IVT and renal dysfunction for primary outcome were.70 (.51-.96; P =.029) and.97 (.71-1.33; P =.865), respectively. No significant interaction was noted between IVT and renal dysfunction (P =.218). Conclusions Renal dysfunction did not modify the effect of IVT for AIS and should not be a reason for withholding treatment from otherwise-eligible patients.",
author = "Hsieh, {Cheng Yang} and Lin, {Huey Juan} and Sung, {Sheng Feng} and Yang, {Yea Huei Kao} and Lai, {Edward Chia Cheng} and Hsieh, {Han Chieh} and Chen, {Chih Hung}",
year = "2015",
month = "3",
day = "1",
doi = "10.1016/j.jstrokecerebrovasdis.2014.11.006",
language = "English",
volume = "24",
pages = "673--679",
journal = "Journal of Stroke and Cerebrovascular Diseases",
issn = "1052-3057",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Does renal dysfunction modify the effect of intravenous thrombolysis for acute ischemic stroke within 4.5 hours of onset? A multicenter observational study

AU - Hsieh, Cheng Yang

AU - Lin, Huey Juan

AU - Sung, Sheng Feng

AU - Yang, Yea Huei Kao

AU - Lai, Edward Chia Cheng

AU - Hsieh, Han Chieh

AU - Chen, Chih Hung

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Background About one third of stroke patients have renal dysfunction. Effect of renal dysfunction on outcome of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) has not been determined in Asia using patients without IVT as comparators. The aim of this study was to examine the interaction between renal dysfunction and IVT on the outcomes in AIS patients admitted within 4.5 hours of onset in a multicenter stroke registry of Taiwan. Methods We identified all consecutive AIS patients admitted within 4.5 hours of onset between 2007 and 2013. Renal dysfunction was defined by an estimated glomerular filtration rate less than 60 mL/minute/1.73 m2 on initial admission. Patients older than 80 years of age and a National Institute of Health Stroke Scale score less than 4 or greater than 25 were excluded. The primary outcome was a modified Rankin Scale score 3-6 at 3 months. We determined the effect of IVT and renal dysfunction on outcome in a multivariate analysis. Results Of the 929 patients analyzed, 39% had renal dysfunction, and 51% received IVT. Primary outcomes occurred in 45% versus 41% of patients with and without renal dysfunction, respectively, (P =.197). In a multivariate analysis, the odds ratios (95% confidence interval; P value) of IVT and renal dysfunction for primary outcome were.70 (.51-.96; P =.029) and.97 (.71-1.33; P =.865), respectively. No significant interaction was noted between IVT and renal dysfunction (P =.218). Conclusions Renal dysfunction did not modify the effect of IVT for AIS and should not be a reason for withholding treatment from otherwise-eligible patients.

AB - Background About one third of stroke patients have renal dysfunction. Effect of renal dysfunction on outcome of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) has not been determined in Asia using patients without IVT as comparators. The aim of this study was to examine the interaction between renal dysfunction and IVT on the outcomes in AIS patients admitted within 4.5 hours of onset in a multicenter stroke registry of Taiwan. Methods We identified all consecutive AIS patients admitted within 4.5 hours of onset between 2007 and 2013. Renal dysfunction was defined by an estimated glomerular filtration rate less than 60 mL/minute/1.73 m2 on initial admission. Patients older than 80 years of age and a National Institute of Health Stroke Scale score less than 4 or greater than 25 were excluded. The primary outcome was a modified Rankin Scale score 3-6 at 3 months. We determined the effect of IVT and renal dysfunction on outcome in a multivariate analysis. Results Of the 929 patients analyzed, 39% had renal dysfunction, and 51% received IVT. Primary outcomes occurred in 45% versus 41% of patients with and without renal dysfunction, respectively, (P =.197). In a multivariate analysis, the odds ratios (95% confidence interval; P value) of IVT and renal dysfunction for primary outcome were.70 (.51-.96; P =.029) and.97 (.71-1.33; P =.865), respectively. No significant interaction was noted between IVT and renal dysfunction (P =.218). Conclusions Renal dysfunction did not modify the effect of IVT for AIS and should not be a reason for withholding treatment from otherwise-eligible patients.

UR - http://www.scopus.com/inward/record.url?scp=84924533567&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84924533567&partnerID=8YFLogxK

U2 - 10.1016/j.jstrokecerebrovasdis.2014.11.006

DO - 10.1016/j.jstrokecerebrovasdis.2014.11.006

M3 - Article

C2 - 25577428

AN - SCOPUS:84924533567

VL - 24

SP - 673

EP - 679

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

IS - 3

ER -