≥75岁急性缺血性脑卒中患者肾小球滤过率估算值对1年死亡的影响研究

Effect of estimated glomerular filtration rate on 1-year mortality in patients with acute ischemic stroke aged≥75 years

目的探讨≥75岁急性缺血性脑卒中(acute ischemic stroke,AIS)患者肾小球滤过率估算值(estimated glomerular filtration rate,eGFR)水平对1年死亡的影响。方法纳入急性脑卒中患者的临床资料,筛选出年龄≥75岁AIS患者,并进行3个月和1年的随访,记录患者是否发生死亡事件。将eGFR按照连续型变量和四分位分组变量(Q1组~Q4组)处理,采用多因素Cox回归分析≥75岁AIS患者eGFR水平对1年死亡的影响。结果最终纳入年龄≥75岁的AIS患者506例。随访3个月和1年时Q1组病死率均明显高于其他组,差异有统计学意义(P<0.05)。校正相关混杂因素后,多因素Cox回归分析显示,eGFR水平每升高5 mL·min^(-1)·(1.73 m^(2))^(-1),年龄≥75岁AIS患者的1年死亡风险降低12.3%(HR=0.877,95%CI:0.8123~0.935,P<0.001);与Q4组相比,Q1组患者3个月死亡风险升高1.890倍(HR=2.890,95%CI:1.010~8.241,P=0.048),1年死亡风险升高1.267倍(HR=2.267,95%CI:1.118~4.596,P=0.023)。Kaplan-Meier生存分析发现,与其他组相比,Q1组生存率明显下降。结论eGFR水平降低是≥75岁AIS患者1年死亡的危险因素,eGFR≤60.2 mL·min^(-1)·(1.73 m^(2))^(-1)可显著增加≥75岁AIS患者1年死亡风险。

Objective To investigate the effect of estimated glomerular filtration rate(eGFR)level on 1-year mortality in patients aged≥75 years with acute ischemic stroke(AIS).Methods Clinical data of patients with acute stroke were included.Patients aged≥75 years with AIS were selected and followed up for 3 months and 1 year respectively,and death events were recorded.The eGFR was treated as continuous variable and quartile grouped variable(group Q1-Q4).Multivariate Cox regression analysis was performed on the effect of eGFR level on 1-year mortality in patients aged≥75 years with AIS.Results A total 506 patients aged≥75 years with AIS were enrolled.The 3-month and 1-year mortality of Q1 group was significantly higher than that of other groups during follow-up,with statistical significance(P<0.001).After adjustment for the related confounders,multivariate Cox regression analysis showed that for every 5 mL·min^(-1)·(1.73 m^(2))^(-1) increase in eGFR level,the risk of 1-year mortality in patients aged≥75 years with AIS decreased by 12.3%(HR=0.877,95%CI:0.8123-0.935,P<0.001).Compared with the Q4 group,the risk of 3-month and 1-year mortality in group Q1 was significantly increased by 1.890 and 1.267 times,respectively(3 months:HR=2.890,95%CI:1.010-8.241,P=0.048;1-year:HR=2.267,95%CI:1.118-4.596,P=0.023).Kaplan-Meier survival analysis found a significant decrease in survival in the Q1 group compared to the other groups.Conclusion Reduced eGFR level is a risk factor for 1-year mortality in patients aged≥75 years with AIS,and eGFR≤60.2 mL·min^(-1)·(1.73 m^(2))^(-1) significantly increases the risk of 1-year mortality in patients aged≥75 years with AIS.