Dynamic decline in estimated glomerular filtration rate associated with in-hospital mortality risk in acute ischemic stroke patients after endovascular therapy: evidence from a Chinese stroke center

TL;DR

A drop in kidney function after stroke treatment is linked to higher in-hospital death risk in stroke patients.

Contribution

Shows that post-treatment kidney function decline, not baseline, predicts mortality in stroke patients.

Findings

Day-3 eGFR decline was strongly linked to higher mortality risk.

Renal dysfunction on day 3 increased death risk by 4.3 times.

eGFR decline also predicted symptomatic intracerebral hemorrhage.

Abstract

To investigate the association between dynamic changes in estimated glomerular filtration rate (eGFR) and in-hospital mortality risk in patients with acute ischemic stroke due to large vessel occlusion (LVO-AIS) undergoing endovascular therapy (EVT).

This retrospective cohort study consecutively enrolled 329 patients with anterior circulation LVO-AIS who underwent EVT between January 2018 and January 2025. The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 equation at admission (baseline), and on days 1 and 3 post-EVT. The primary outcome was all-cause in-hospital mortality. Multivariable logistic regression models and restricted cubic spline regression were employed to assess the association between eGFR and outcomes. Subgroup analyses with interaction testing were conducted to evaluate the consistency of this association across different patient populations.

Of the 329 patients, 49 (14.9%) died during hospitalization. Baseline eGFR was not significantly associated with mortality (P = 0.223), whereas post-EVT eGFR demonstrated a pronounced time-dependent association. Patients who died exhibited a progressive decline in eGFR (P < 0.05), while survivors showed a modest increase (P < 0.01). After comprehensive adjustment for confounders, each 1 mL/min/1.73 m2 decrease in day-3 eGFR was associated with a 3% increase in mortality risk (P < 0.001); moderate-to-severe renal dysfunction (eGFR < 60 mL/min/1.73 m2) on day 3 was associated with a 4.3-fold increased risk of death (P < 0.001). Subgroup analyses revealed consistent associations across subgroups, with no significant interactions (all P for interaction > 0.05). Furthermore, post-EVT eGFR decline was significantly associated with increased risk of symptomatic intracerebral hemorrhage (sICH) (P < 0.001), but not with hemorrhagic transformation (HT).

Dynamic decline in eGFR, particularly the level on day 3 post-EVT, is independently associated with in-hospital mortality in LVO-AIS patients undergoing EVT, exhibiting a clear dose-response relationship.

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