The Joint Effect of Renal Function Status and Coagulation Biomarkers on In-Hospital Outcomes in Acute Ischemic Stroke Patients With Intravenous Thrombolysis

Objective

To demonstrate whether combining renal function status [estimating glomerular filtration rate (eGFR)] with coagulation biomarkers [fibrinogen (Fg) and d-dimer] is more beneficial in predicting in-hospital outcomes following intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients.

Methods

We studied 417 AIS patients with IVT. According to the cut-offs of coagulation biomarkers (Fg and d-dimer) and eGFR determined by receiver operating characteristic (ROC) curves, the patients were divided into four groups: LFLG (low Fg and low eGFR), LFHG (low Fg and high eGFR), HFLG (high Fg and low eGFR), and HFHG (high Fg and high eGFR); or LDLG (low d-dimer and low eGFR), LDHG (low d-dimer and high eGFR), HDLG (high d-dimer and low eGFR), and HDHG (high d-dimer and high eGFR). Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for poor outcomes at discharge and post-stroke pneumonia across the four groups.

Results

The patients in the HFLG and HDLG groups had the poorest prognosis at discharge and the highest risk of in-hospital pneumonia. They experienced 3.00 or 4.59 times higher risk of in-hospital pneumonia than those in the LFHG and LDHG groups (95%CI: 1.07–8.44, p < 0.05; 95%CI: 1.58–13.32, p = 0.005). Similarly, the risk of adverse outcome at discharge was 3.02 and 1.52 times higher in HFLG and HDLG groups (95%CI: 1.63–9.91, p < 0.005; 95%CI: 1.11–5.74, p < 0.05) compared to that in LFHG and LDHG groups. Adding eGFR and Fg or d-dimer to the risk model improved the risk reclassification for in-hospital pneumonia and functional outcomes at discharge.

Conclusion

Combining renal function status and coagulation biomarkers within 4.5 h after onset could better predict in-hospital outcomes of AIS patients with IVT.