Beyond the Threshold: Continuous Creatinine Change and Outcomes After Endovascular Thrombectomy for Acute Ischemic Stroke.
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Schwarz Ghil, Cascio Rizzo Angelo, Ambler Gareth, Wrona Pawel, Slowik Agnieszka, Bodzioch Aleksandra, Doheim Mohamed F, Al-Bayati Alhamza R, Nogueira Raul G, Nunes Ana Paiva, Ferreira Patricia, Paolucci Matteo, Zini Andrea, Simonetti Luigi, Leško Norbert, Fedorko Jakub, Gdovinová Zuzana, Scarcia Luca, Kalsoum Erwah, Farhat Firas, Beyeler Morin, Mujanovic Adnan, Arnold Marcel, Meira Torcato, Morais Marta, Francisco Leonor, Wiącek Marcin, Pudło Paulina, Bartosik-Psujek Halina, Calleja Patricia, Ostos Fernando, Seoane David, Anca Negrila, Radu Razvan Alexandru, Tiu Cristina, Al Kasab Sami, Abu Qdais Ahmad, Samman Tahhan Imad, Ayo-Martin Oscar, Hernández-Fernández Francisco, Paya Maria, Molina-Nevo Juan David, Labuz-Roszak Beata Maria, Toni Danilo, Moszko Karolina, Roszak Mateusz Łukasz, De Michele Manuela, Barrile Elena, Eswaradass Prasanna, Houghton Margaret L, Barkley Tiffany, Ali Amir, Demeestere Jelle, Bauknight Wayne Martin, Sheth Sunil Anil, Maes Louise, Wouters Anke, Marto João Pedro, Costa José Blazer, Loizzo Nicola Davide, Romi Andrea, Currò Carmelo Tiberio, Luchowski Piotr, Seweryn Maksymilian, Rejdak Konrad, Klein Piers, Abdalkader Mohamad, Saia Valentina, Sanna Antioco, Tassinari Tiziana, Acampa Maurizio, Rosini Francesca, Tassi Rossana, Bilik Marta Ewa, Bandzarewicz-Samcik Anna Maria, Min Jiangyong, HajAissa Naser, Mangiardi Marilena, Anticoli Sabrina, Pampana Enrico, Hervás-Testal Carlos, Rigual Ricardo, Fuentes Blanca, Strambo Davide, Tetaria Carl Manuata, Saliou Guillaume, Caramma Andrea Salvatore, Maimone Davide, Rizzo Pier Andrea, Moci Marco, Scala Irene, Cruz-Culebras Antonio, Vera Lechuga Rocío, Garcia Madrona Sebastian, Merlino Giovanni, Valente Mariarosaria, Todesco Arianna, Bolognese Manuel, Lakatos Lehel-Barna, Karwacki Grzegorz Marek, Candelaresi Paolo, Andreone Vincenzo, Maurea Carlo, Tarletti Roberto, Mele Angelica, Ciacciarelli Antonio, Alessiani Michele, Monteforte Gabriella, Pakizer David, Roubec Martin, Školoudík David, Vandervorst Fenne, De Raedt Sylvie, Verdam Martijn, Bartoš Josef, Šrámek Martin, Mazzoleni Valentina, Quilici Luca, Alimonti Dario, Moller Jessica, Maestrini Ilaria, Diomedi Marina, Lacidogna Giordano, Zaidat Osama O, Lin Eugene, AlMajali Mohammad, Baracchini Claudio, Zaccagnino Matteo, Viaro Federica, Pezzini Alessandro, Avola Giulia, Ferraro Chiara, Świtońska Milena, Sobieszak-Skura Paulina, Meder Grzegorz, Mayer-Suess Lukas, Knoflach Michael, Gizewski Elke Ruth, Common Matthew R, Nicholson Patrick, Power Sarah, Nowakowska-Kotas Marta Małgorzata, Pula Michał, Guzinski Maciej, Pérez Sánchez Soledad, Montaner Joan, Sevilla Bravo Alexandra, Marcheselli Simona, Vodret Francesca, Rapillo Costanza, Pereira Liliana, Rodrigues Miguel, Jaros Adam, Kovar Martin, Vojik Jan, Valcamonica Gloria, Gallo Cassarino Serena, Cardillo Alessandra, Petruzzellis Marco, Grimaldi Silvia, Marrone Nicola, Hassan Ameer E, Miller Samantha, Khasawneh Mohammad W, Poretto Valentina, Tonello Simone, Tollot Saverio, Dębiec Aleksander, Staszewski Jacek, Stepien Adam, Bernardo Francisco, Ferrao Jorge, Zedde Marialuisa, Pascarella Rosario, Sanna Alessandra, Meloni Rossella, Delibas Kati, Sacco Simona, Vittorini Maria Grazia, Ornello Raffaele, Mannino Marina, Terruso Valeria, Filizzolo Marco, Hall Emily, Roffe Christine, Dorobek Małgorzata, Zielinska-Turek Justyna, Scopelliti Giuseppe, Pantoni Leonardo, Pero Guglielmo Carlo, Macera Antonio, Cervo Amedeo, Bellavia Simone, Longoni Marco, Sezgin Mine, Dilmen Yavuz, Ekizoglu Esme, Tsivgoulis Georgios, Theodorou Aikaterini, Tiu Vlad Eugen, Panea Cristina Aura, Petrescu Simona, Piano Mariangela, Nguyen Thanh N, Sessa Maria
Аннотация
METHODS: We performed a secondary analysis of the CAN-REST (Contrast-Associated Nephropathy After Endovascular Stroke Treatment; REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06596603) registry, a retrospective multicenter observational cohort study of 6638 EVT-treated adults with acute ischemic stroke enrolled at 73 centers in 16 countries between January 1 and December 31, 2023. Early creatinine change was quantified as the natural logarithm ratio of 48-hour creatinine to baseline creatinine (ln[48-hour/baseline creatinine]), with CA-AKI defined per Kidney Disease: Improving Global Outcomes criteria (≥0.3 mg/dL or ≥1.5× baseline rise within 48 hours). Multivariable logistic regression adjusted for prespecified baseline and periprocedural covariates examined associations with 90-day modified Rankin Scale shift and in-hospital mortality; linear versus restricted cubic spline specification was selected by likelihood ratio testing, and contrasts were estimated at ±10%, ±25%, and ±50%.
RESULTS: Greater creatinine worsening within 48 hours of EVT was independently associated with an unfavorable 90-day modified Rankin Scale shift (adjusted common odds ratio per 1-unit log-ratio increase, 1.48 [95% CI, 1.07-2.04]; linear) and in-hospital mortality (nonlinear dose-response, of larger magnitude). A 10% increase in creatinine at 48 hours-well below Kidney Disease: Improving Global Outcomes threshold-was associated with worse functional outcome (adjusted common odds ratio, 1.04 [95% CI, 1.01-1.07]) and death (adjusted odds ratio, 1.22 [95% CI, 1.13-1.32]); a 10% decrease in creatinine at 48 hours was associated with lower odds of both outcomes (adjusted common odds ratio, 0.96 [95% CI, 0.93-0.99] and 0.74 [95% CI, 0.65-0.86]). The functional-outcome association concentrated at upper modified Rankin Scale cut-points (severe disability, death); effect modification by baseline renal function was not significant.
CONCLUSIONS: Early creatinine change after EVT conveys graded, outcome-specific prognostic information extending below formal CA-AKI thresholds, with a dose-response detectable at changes as modest as ±10%, complementing binary CA-AKI as a framework for post-EVT renal risk assessment.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06596603.