Neurotoxicity Research

, Volume 35, Issue 2, pp 441–450 | Cite as

Dynamic Changes in the Estimated Glomerular Filtration Rate Predict All-Cause Mortality After Intravenous Thrombolysis in Stroke Patients

  • Jijun Shi
  • Yuanyuan Liu
  • Yiteng Liu
  • Huihui Liu
  • Jiaping Xu
  • Xia Zhang
  • Shoujiang You
  • Yongjun CaoEmail author


Little is known about the prognostic value of the estimated glomerular filtration rate (eGFR) and the effect of dynamic changes in the eGFR on mortality in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). We aim to investigate the association between the eGFR and dynamic changes in the eGFR after IVT with all-cause mortality in AIS patients. A total of 391 AIS patients treated with IVT between May 2010 and May 2017 were included in the final analysis. Serum creatinine was measured at admission and within 24 h after IVT. The main outcomes included 3-month all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). During the 3-month follow-up, 37 (9.5%) patients died from all causes. Mortality was associated with a reduced eGFR at admission (adjusted hazard ratio (HR), 4.17; 95% confidence interval (CI), 1.50–11.58; P trend = 0.016) and within 24 h after IVT (adjusted HR, 5.88; 95% CI, 1.41–24.52; P trend = 0.009). Mortality was negatively correlated with increased eGFR after IVT (adjusted HR, 0.70; 95% CI, 0.51–0.96; P trend = 0.027). Additionally, a reduced eGFR after IVT was also associated with increased risk of MACCE (adjusted HR, 3.64; 95% CI, 1.41–9.39; P trend = 0.009). Using a multivariable Cox regression model with restricted cubic splines, we observed an L-shaped association between the eGFR and 3-month all-cause mortality and MACCE and observed a linear association between dynamic changes in the eGFR and 3-month all-cause mortality. A reduced eGFR and dynamic decreases in the eGFR after IVT independently predict 3-month all-cause mortality in AIS patients.


Estimated glomerular filtration rate Acute ischemic stroke Mortality Intravenous thrombolysis Recombinant tissue plasminogen activator 



The authors wish to thank the clinical staff for their support in providing data and in contributing to this study.

Sources of Funding

This work was supported by the National Natural Science Foundation of China [grant number 81471195], the Suzhou Clinical Research Center of Neurological Disease [grant number szzx201503], the Second Affiliated Hospital of Soochow University Preponderant Clinic Discipline Group Project Funding [grant number XKQ2015002], and the Suzhou Youth Science and Technology Project [grant number KJXW2015010].

Compliance with Ethical Standards

The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Soochow University and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all the participants or from their caregivers.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

12640_2018_9970_MOESM1_ESM.docx (20.8 mb)
ESM 1 (DOCX 21327 kb)


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
  2. 2.Department of ElectrocardiographyThe Affiliated Guangji Hospital of Soochow UniversitySuzhouChina
  3. 3.Department of ElectrocardiographySuzhou Psychiatric HospitalSuzhouChina

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