对比剂相关急性肾损伤对缺血性脑卒中患者近期预后的影响

The short-time mortality in ischemic stroke patients with contrast-induced acute kidney injury

目的：观察缺血性卒中患者脑血管造影后对比剂相关急性肾损伤（CI-AKI）对住院死亡率及1年死亡率的影响。方法：回顾性纳入2009-01-01~2013-12-31在广东省人民医院接受脑血管造影介入术的缺血性脑卒中患者,收集患者造影前、造影过程中及造影后相关临床资料,通过多因素回归模型分析CI-AKI对住院死亡率及1年死亡率的影响。结果：共有1 820例接受脑血管造影的缺血性脑卒中患者纳入本研究,其中81例（4.5%）患者发生了CI-AKI。多因素Logistic回归模型显示脑血管造影后CI-AKI增加患者住院死亡风险（优势比OR=3.99;95%CI 1.43~11.14;P=0.008）,同时多因素COX回归模型显示CI-AKI也是1年死亡的独立危险因素（风险比HR=1.96;95%CI 1.18~3.26;P=0.009）。结论：脑血管造影后CI-AKI是缺血性卒中患者住院死亡及1年死亡的独立危险因素,对接受脑血管造影患者采取有效措施预防CI-AKI十分必要。

Objective： The association between contrast-induced acute kidney injury（ CI-AKI） and prognosis in cerebrovascular patients is still unknown. This study aimed to determine whether CI-AKI is a risk factor for in-hospital mortality and 1-year mortality in ischemic stroke patients undergoing cerebral angiography. Methodology： This retrospective observational study consisted of consecutive cerebral ischemic stroke patients undergoing cerebral angiography at Guangdong General Hospital between January 2009 and December 2013. Patient demographics,medical history,physical examination,National Institute of Health Stroke scale（ NIHSS） score of neurological deficit,medication use,laboratory findings,procedural characteristics,length of stay in the hospital,requirement for renal replacement therapy（ RRT）,date of in-hospital death,and date of 1-year death were collected. Univariate and multivariate logistic regression analyses were used to determine whether CI-AKI was an independent risk factor for in-hospital mortality. Cox regression was performed to assess the correlation between CI-AKI and 1-year mortality. Results： A total of 1 820 ischemic stroke patients undergoing cerebral angiography were analyzed. CI-AKI was observed in 81 patients（ 4. 5%） and was significantly associated with a higher rate of in-hospital mortality（ 13. 6% vs 4. 8%,P〈0. 001） and 1-year mortality（ 37. 0% vs18. 3%,P〈0. 001）. CI-AKI didn＇t increase the length of stay in the hospital（ 31. 3 ± 16. 4 days vs 30. 2 ± 16. 0 days,P= 0. 540）. After adjusting for potential confounding risk factors,patients with CI-AKI had a 4-fold higher risk of compared with patients without CI-AKI（ odds ratio [OR]3. 99; 95% confidence interval [CI]1. 43 ~ 11. 14; P = 0. 008）. CI-AKI also increased 1-year hospital mortality independently（ hazard ratio [HR] 1. 96,95% CI 1. 18- 3. 26; P = 0. 009）.Conclusion： CI-AKI is an independent risk factor for in-hospital mortality and 1-year mortality in ischemic stroke patients undergoing cerebral angiography.