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Urinary Microalbumin predicts early neurological deterioration in acute ischemic stroke: A study based on etiological
Huan Huang1, Xuan-Fei Jiang1, Xiang-Yan Yang1
1Department of Neurology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, Zhejiang, PR China.
Introduction:
To investigate the correlation between urinary microalbumin (U-Alb) levels and early neurological deterioration (END), as well as its predictive ability, in patients with acute ischemic stroke (AIS) under different etiological subtypes.
Materials And Methods:
We consecutively enrolled AIS patients within 72 h of onset, collecting relevant clinical characteristics and baseline laboratory data including U-Alb. END was defined as an increase of ≥4 points in NIHSS score within 72 h of onset, and TOAST criteria were used for stroke etiologic typing. Binary logistic regression analysis was employed to clarify the association between baseline U-Alb and the occurrence of END under different stroke etiological subtypes. ROC analysis was conducted to evaluate its predictive ability under different etiological subtypes.
Results:
Finally, 615 patients were included, with 104 (16.9 %) developed END. Binary logistic regression analysis revealed that baseline U-Alb was independently associated with END occurrence (OR = 1.009, 95 % CI 1.002-1.016, p = 0.009). ROC analysis revealed that U-Alb had the best predictive ability for patients with small artery occlusion (AUC=0.707, p < 0.001), followed by large artery atherosclerosis (AUC = 0.632, p = 0.006), with corresponding optimal diagnostic cutoff points of 31.11 and 25.71 mg/L, respectively. However, U-Alb was not an independent risk factor for END in cardioembolic stroke patients (OR = 1.011, 95 % CI 0.980-1.043, p = 0.478). MAU was associated with stroke progression(p = 0.023), and U-Alb was positively correlated with increased infarct volume (r = 0.516, p < 0.01).
Conclusion:
U-Alb is closely associated with END in AIS patients, serving as a potential indicator for predicting END, especially among those with small artery occlusion mechanisms.
Insights
Urinary microalbumin (U-Alb) is linked to early neurological deterioration (END) in acute ischemic stroke (AIS) patients. U-Alb shows predictive value for END, particularly in small artery occlusion stroke subtypes.
Area of Science:
- Neurology
- Nephrology
- Cardiovascular Medicine
Background:
- Early neurological deterioration (END) is a critical complication in acute ischemic stroke (AIS).
- Urinary microalbumin (U-Alb) is a marker of endothelial dysfunction and kidney damage.
- The relationship between U-Alb and END in AIS, considering different etiological subtypes, requires further investigation.
Purpose of the Study:
- To examine the correlation between baseline urinary microalbumin (U-Alb) levels and early neurological deterioration (END) in patients with acute ischemic stroke (AIS).
- To assess the predictive capability of U-Alb for END across various etiological subtypes of AIS.
- To explore the association of U-Alb with stroke progression and infarct volume.
Main Methods:
- Consecutive enrollment of AIS patients within 72 hours of symptom onset.
- Collection of clinical data, baseline laboratory results, including U-Alb levels.
- Definition of END as ≥4-point increase in NIHSS score within 72 hours; etiological typing using TOAST criteria.
- Application of binary logistic regression and ROC analysis to determine associations and predictive values.
Main Results:
- A total of 615 AIS patients were analyzed, with 16.9% experiencing END.
- Baseline U-Alb was independently associated with END occurrence (OR=1.009, p=0.009).
- U-Alb demonstrated predictive ability for END in small artery occlusion (AUC=0.707) and large artery atherosclerosis (AUC=0.632) subtypes, but not in cardioembolic stroke.
- U-Alb correlated positively with increased infarct volume (r=0.516, p<0.01).
Conclusions:
- Urinary microalbumin (U-Alb) is significantly associated with early neurological deterioration (END) in acute ischemic stroke (AIS) patients.
- U-Alb serves as a potential predictor for END, especially in AIS patients with small artery occlusion.
- These findings highlight the role of microalbuminuria in stroke pathophysiology and prognosis.
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