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Low Creatinine Clearance Is a Risk Factor for Severe Cardioembolic Stroke in Japanese Female Patients
Shuntaro Sakai1, Joji Hagii2, Shun Shikanai1
1Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Insights
Reduced creatinine clearance (CCr) is linked to more severe cardioembolic strokes (CES) and worse outcomes, especially in women. This finding highlights the importance of renal function in stroke severity and prognosis.
Area of Science:
- Neurology
- Nephrology
- Cardiology
Background:
- The impact of renal function on cardioembolic stroke (CES) severity and outcomes, particularly when stratified by sex, is not well understood.
- Creatinine clearance (CCr) is a key indicator of renal function.
Purpose of the Study:
- To investigate the relationship between varying levels of creatinine clearance (CCr) and the severity and functional outcomes of cardioembolic stroke (CES).
- To determine if this relationship differs between male and female patients.
Main Methods:
- A cohort of 640 CES patients was analyzed within 48 hours of stroke onset.
- Patients were categorized into three groups based on CCr: low (<30 ml/min), middle (30 to <50 ml/min), and high (≥50 ml/min).
- Stroke severity (NIHSS) and functional outcomes (mRS) were compared across groups and stratified by sex.
Main Results:
- Patients with low CCr exhibited the most severe strokes on admission and the worst functional outcomes at discharge.
- Low CCr was a significant predictor of stroke severity and poor outcomes.
- This association was significant in female patients but not in male patients.
Conclusions:
- Low creatinine clearance (CCr) is a significant risk factor for severe cardioembolic stroke (CES) and unfavorable outcomes.
- The impact of low CCr on stroke severity and outcomes is particularly pronounced in female patients.
Background/Aim:
The relationship between renal function and severity of cardioembolic stroke (CES) stratified by sex remains poorly understood.
Patients And Methods:
A total of 640 consecutive CES patients within 48 h after stroke onset and with a modified Rankin Scale (mRS) score of 0 or 1 before onset were studied. The patients were divided into three groups based on their CCr values: low creatinine clearance (CCr) (L-CCr) (n=71, <30 ml/min), middle CCr (M-CCr) (n=227, 30 to <50 ml/min), and high CCr (H-CCr) (n=342, ≥50 ml/min). We compared the severity and functional outcomes of stroke among the three groups according to sex.
Results:
On admission, using the National Institutes of Health Stroke Scale, the L-CCr group had the most severe stroke, followed by the M-CCr and H-CCr groups (p<0.0001). Functional outcomes at discharge, assessed using the mRS, were the worst in the L-CCr group, followed by the M-CCr and H-CCr groups (p<0.0001). Multivariable analyses revealed that L-CCr was a significant determinant of severe stroke on admission and poor functional outcomes at discharge. According to sex, L-CCr was a significant determinant of severe stroke on admission and poor functional outcomes at discharge in female patients, but not in male patients.
Conclusion:
Low CCr is a risk factor for severe stroke on admission and unfavorable functional outcomes at discharge in Japanese CES patients, and particularly in female patients.
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