Title:Low Baseline Urine Creatinine Excretion Rate Predicts Poor Outcomes among Critically Ill Acute Stroke Patients
Volume: 12
Issue: 1
Author(s): Chia-Yu Hsu, Yi-Ling Wu, Chun-Yu Cheng, Jiann-Der Lee, Ying-Chih Huang, Ming-Hsueh Lee, Chih-Ying Wu, Huan-Lin Hsu, Ya-Hui Lin, Yen-Chu Huang, Hsin-Ta Yang, Jen-Tsung Yang, Meng Lee and Bruce Ovbiagele
Affiliation:
Keywords:
Urine creatinine excretion rate, stroke, critically ill, outcome.
Abstract: Urinary creatinine excretion rate (CER) is an established marker of muscle mass. Low CER has
been linked to poor coronary artery disease outcomes, but a link between CER and acute stroke prognosis
has not been previously explored. We prospectively collected data from patients with acute stroke (ischemic
or hemorrhagic) within 24 hours from symptom onset in a Neurological and Neurosurgery Intensive Care
Unit in Taiwan. Baseline CER (mg/d) was calculated by urine creatinine concentration in morning spot urine multiplies
24-hour urine volume on the second day of admission. Patients were divided into 3 tertiles with highest, middle, and
lowest CER. Primary endpoint was poor outcome defined as modified Rankin Scale 3-6 at 6 months. Among 156
critically ill acute stroke patients meeting study entry criteria, average age was 67.9 years, and 83 (53.2%) patients had
ischemic stroke. Patients with lowest CER (vs. highest CER) had a high risk of poor outcome at 6-month after adjustment
(odds ratio 4.96, 95% confidence interval 1.22 to 20.15, p value = 0.025). In conclusion, low baseline CER, a marker of
muscle mass, was independently associated with poor 6-month outcome among critically ill acute stroke patients. We
speculate that preservation of muscle mass through exercise or protein-energy supplement might be helpful for improving
prognosis in severe stroke patients.
