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Utility of urinalysis in discriminating cardioembolic stroke mechanism
J Alex Viehman1, Jeffrey L Saver, David S Liebeskind
1School of Medicine, Temple University, Philadelphia, Pennsylvania 19140, USA. viehman@temple.edu
Insights
Elevated urine red blood cell and white blood cell counts may help identify cardioembolic stroke early. Urinalysis can aid in discriminating cardioembolic (CE) from non-CE stroke in acute ischemic stroke patients.
Area of Science:
- Neurology
- Nephrology
- Cardiology
Background:
- Acute ischemic stroke is a leading cause of disability and death.
- Determining the stroke subtype is crucial for appropriate treatment and secondary prevention.
- Cardioembolic (CE) stroke, originating from cardiac sources, requires specific management strategies.
Purpose of the Study:
- To evaluate the utility of urine erythrocyte (red blood cell) and leukocyte (white blood cell) counts in differentiating cardioembolic (CE) stroke from non-CE stroke in patients with acute ischemic stroke.
- To assess if urinalysis findings can serve as early indicators for CE stroke.
Main Methods:
- A cohort of 341 patients presenting with acute ischemic stroke within 24 hours of symptom onset was studied.
- Urinalysis parameters (white blood cell count, red blood cell count, specific gravity, glucose, protein) and clinical data were analyzed.
- Multivariate analysis using a classification and regression tree model was employed to identify predictors of CE stroke.
Main Results:
- Elevated urine white blood cell count, red blood cell count, urine specific gravity, and serum creatinine levels were significantly associated with the CE stroke subtype.
- The classification and regression tree model achieved an overall accuracy of 71.5% in classifying stroke subtypes.
- Specific thresholds for urine white blood cell count (>14.5/microL), urine red blood cell count (>41.7/microL), and serum creatinine (>1.08 mg/dL) were identified as key predictors for CE stroke.
Conclusions:
- Urinalysis findings, particularly elevated erythrocyte and leukocyte counts, show potential utility in the early identification of the cardioembolic stroke subtype.
- This non-invasive method may assist clinicians in discriminating CE from non-CE stroke, guiding timely therapeutic interventions.
Objective:
To determine whether elevated urine erythrocyte (red blood cell) and leukocyte (white blood cell) counts, reflecting concomitant renal and cerebral emboli of cardiac origin, would be useful in discriminating cardioembolic (CE) from non-CE stroke in acute ischemic stroke.
Design:
Consecutive patients presenting within 24 hours of ischemic stroke over 3(3/4) years were studied. Patient medical history and urinalysis data, including white blood cell count, red blood cell count, specific gravity, and glucose and protein levels at admission, were analyzed and compared with the final determination of stroke subtype. Multivariate analysis (CE vs non-CE stroke) was performed using a classification and regression tree that included all 5 urine variables as potential predictors. Additional predictors entered into the classification and regression tree model were age, presence of urinary tract infection at admission, history of hypertension, history of diabetes mellitus, and serum creatinine level.
Results:
A total of 341 individuals met the study criteria. Their mean age was 68.6 years; 49.8% were female, 70.9% were white, and 38.7% had the CE stroke subtype. In bivariate analysis, age (P = .009), urine white blood cell count (P = .02), urine red blood cell count (P = .005), urine specific gravity (P = .02), and serum creatinine level (P = .02) were significantly higher in those with the CE vs the non-CE stroke subtype. In the classification and regression tree, 58.3% of those with CE stroke were correctly classified and 84.7% of those with non-CE stroke were correctly classified, for an overall accuracy of 71.5%. The best single predictor for the CE stroke subtype was a white blood cell count of greater than 14.5/microL, followed by a red blood cell count of greater than 41.7/microL and a serum creatinine level greater than 1.08 mg/dL (>95.5 micromol/L). Based on the distribution in the first 2 divisions in the tree, a patient could be placed into 1 of 4 categories that corresponded to 3 levels of CE stroke likelihood: low (25%), moderate (50%), and high (80%).
Conclusion:
Urinalysis may have utility in the early identification of the CE stroke subtype in patients with acute ischemic stroke.
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