@article{52fb64a12f614a0bb8541883d9a74b51,
title = "Prognostic impact of renal dysfunction on embolic stroke of undetermined source—Role beyond CHA2DS2-VASc score: Results from Taiwan Stroke Registry",
abstract = "Background and purpose: The CHA2DS2-VASc score has immense prognostic value in patients with embolic stroke of undetermined source (ESUS). We aimed to determine the usefulness of advanced renal dysfunction and its addition to the CHA2DS2-VASc score in improving predictive accuracy. Methods: In total, 3775 ESUS patients were enrolled from a nationwide hospital-based prospective study. Advanced renal dysfunction was defined as estimated glomerular filtration rate <30 ml/min per 1.73 m2 or patients under dialysis. Clinical outcomes included recurrent stroke and 1-year all-cause mortality. Poor functional outcome was defined as a modified Rankin Scale >2 at first-, third-, and sixth-month post-stroke. The renal (R)-CHA2DS2-VASc score was derived by including advanced renal dysfunction in the CHA2DS2-VASc score. Risk stratification improvement after including advanced renal dysfunction was assessed using C statistic, integrated discrimination improvement (IDI), and category-free net reclassification index (NRI). Results: After adjusting for confounding factors and CHA2DS2-VASc score, advanced renal dysfunction showed significant associations with all-cause mortality (HR: 2.88, 95% CI: 1.92–4.34) and poor functional outcome at third- (OR: 2.69, 95% CI: 1.47–4.94) and sixth-month post-stroke (OR: 2.67, 95% CI: 1.47–4.83). IDI and NRI showed that incorporating advanced renal dysfunction significantly improved risk discrimination over the original CHA2DS2-VASc score. R-CHA2DS2-VASc score ≥2 increased risk by 1.94-fold (95% CI: 1.15–3.27) for all-cause mortality, and ≥4 increased risk by 1.62-fold (95% CI: 1.05–2.50) of poor functional outcome at third-month post-stroke and by 1.81-fold (95% CI: 1.19–2.75) at sixth-month post-stroke. Conclusions: Advanced renal dysfunction was significantly associated with clinical and functional outcomes in ESUS patients and may improve prognostic impact of the CHA2DS2-VASc score.",
keywords = "CHADS-VASc score, ESUS, renal dysfunction",
author = "{Taiwan Stroke Registry Investigators} and Chua, {Su Kiat} and Hsieh, {Fang I.} and Hu, {Chaur Jong} and Wang, {I. Kuan} and Lee, {Jiunn Tay} and Yeh, {Hsu Ling} and Lin, {Kuan Yu} and Lai, {Ta Chang} and Yu Sun and Jeng, {Jiann Shing} and Lin, {Cheng Li} and Lien, {Li Ming} and Hsu, {Chung Y.}",
note = "Funding Information: This study was funded in part by the Bureau of Health Promotion, Department of Health Taiwan Stroke Registry grant (DOH-95-98-HP-1102); Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW109-TDU-B-212-114004), China Medical University Hospital; Academia Sinica Stroke Biosignature Project (BM10701010021); MOST Clinical Trial Consortium for Stroke (MOST 109-2321-B-039-002); China Medical University Hospital (DMR-109-231); Shin Kong Wu Ho-Su Memorial Hospital (SKH-8302-106-DR-11 and 2018SKHADR013); Tseng-Lien Lin Foundation, Taichung, Taiwan;?and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. Funding Information: This study was funded in part by the Bureau of Health Promotion, Department of Health Taiwan Stroke Registry grant (DOH‐95‐98‐HP‐1102); Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW109‐TDU‐B‐212‐114004), China Medical University Hospital; Academia Sinica Stroke Biosignature Project (BM10701010021); MOST Clinical Trial Consortium for Stroke (MOST 109‐2321‐B‐039‐002); China Medical University Hospital (DMR‐109‐231); Shin Kong Wu Ho‐Su Memorial Hospital (SKH‐8302‐106‐DR‐11 and 2018SKHADR013); Tseng‐Lien Lin Foundation, Taichung, Taiwan; and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. Funding Information: The TSR program is a nationwide hospital‐based prospective study started in 2006, involving 65 academic and community hospitals in Taiwan. It is a research project funded by the Ministry of Health and Welfare [ 20 ] and approved by the Research Ethics Committee, China Medical University and Hospital, Taichung, Taiwan. The use of TSR as a human study protocol was approved by the Institutional Review Board of each participating hospital. Stroke patients who presented to the hospitals within 10 days of stroke onset were entered into the registry after signing informed consent forms giving permission for follow‐up at the first‐, third‐, and sixth‐month post‐stroke onset in outpatient clinic visits and/or via telephone interviews conducted by trained nurses who served as stroke case managers. Publisher Copyright: {\textcopyright} 2020 European Academy of Neurology",
year = "2021",
month = apr,
doi = "10.1111/ene.14662",
language = "English",
volume = "28",
pages = "1253--1264",
journal = "European Journal of Neurology",
issn = "1351-5101",
publisher = "Wiley-Blackwell",
number = "4",
}