Early eGFR fluctuation and 180-day outcome after thrombectomy for large-artery atherosclerotic stroke.

BACKGROUND

To investigate whether early estimated glomerular filtration rate (eGFR) fluctuation is associated with 180-day functional outcome in patients with large-artery atherosclerotic stroke undergoing endovascular thrombectomy.

METHODS

We conducted a multicenter retrospective cohort study of consecutive patients with acute ischemic stroke attributed to large-artery atherosclerosis who underwent endovascular thrombectomy between January 1, 2024 and December 31, 2024. Among 108 patients with 180-day follow-up, 93 had at least two actual eGFR measurements within the first 7 days and comprised the primary complete-case cohort; the full 108-patient cohort after multiple imputation was examined in a sensitivity analysis. Early eGFR fluctuation was defined as the absolute difference between the maximum and minimum eGFR values within 7 days after admission. Poor functional outcome was defined as a modified Rankin Scale score of 3-6 at 180 days.

RESULTS

In the primary cohort of 93 patients, 54 had poor functional outcomes. Greater early eGFR fluctuation was associated with poor 180-day functional outcome (adjusted OR per 1 mL/min/1.73 m2 increase, 1.078; 95% CI, 1.019-1.139; p = 0.008). The association was consistent in Firth penalized regression (OR, 1.068; 95% CI, 1.020-1.134; p = 0.002) and bootstrap internal validation. It remained significant after adjustment for the number of eGFR measurements (adjusted OR, 1.065; 95% CI, 1.006-1.127; p = 0.029) and in the 108-patient post-imputation sensitivity cohort (adjusted OR, 1.089; 95% CI, 1.030-1.151; p = 0.003). Restricted cubic spline analysis showed an overall association (p = 0.012) without evidence of nonlinearity (p = 0.471).

CONCLUSION

Greater early eGFR fluctuation was associated with poor 180-day functional outcome after thrombectomy in patients with large-artery atherosclerotic stroke. Early eGFR fluctuation may represent an exploratory prognostic marker that requires prospective external validation.