Renal dysfunction is associated with lower odds of home discharge for patients with stroke

Studies on the association of estimated glomerular filtration rate (eGFR) levels with hospital discharge disposition after stroke are limited with inconsistent results. This study investigated the odds of home discharge with eGFR levels at admission for patients with stroke using the Taiwan Stroke Registry (TSR) data.
From the TSR database, a total of 51,338 stroke patients from 2006 to 2015 were categorized into five groups based on eGFR levels at admission. The proportion of home discharge by the eGFR levels was calculated and logistic regression analysis was used to estimate the related odds ratio (OR) and 95% confidence interval.
Near 85% of stroke patients were discharged to home. The proportion of home discharges decreased as the eGFR level declined. Compared to patients with eGFR ≥90 mL/min/1.73 m2, the adjusted ORs of home discharge were 0.91, 0.85, 0.63, 0.56 for patients with eGFR 60–89, eGFR 30–59, eGFR 15–29, and eGFR < 15 mL/min/1.73 m2 or on dialysis, respectively, in a graded relationship. The trends were consistent in the ischemic stroke and hemorrhagic stroke patients. The areas under the receiver operating characteristic curve for all stroke patients, ischemic stroke patients, and hemorrhagic stroke patients were 0.801, 0799, 0.815, respectively.
The odds of home discharge for stroke patients decreased with a significant independent graded association with declining eGFR levels. Renal function could predict home discharge after stroke.

目前针对卒中患者入院时估算肾小球滤过率（estimated glomerular filtration rate, eGFR）水平与卒中后出院安置情况之间关联的研究较为匮乏，且所得结果存在不一致性。本研究采用中国台湾卒中登记库（Taiwan Stroke Registry, TSR）的数据，探讨卒中患者入院时eGFR水平与居家出院几率的相关性。
本研究从TSR数据库中筛选出2006至2015年间的51338例卒中患者，依据入院时eGFR水平将其分为五组；计算不同eGFR分组的居家出院比例，并通过logistic回归分析估算相关比值比（odds ratio, OR）及95%置信区间。
近85%的卒中患者最终居家出院。居家出院比例随eGFR水平降低呈下降趋势。以eGFR≥90 mL/min/1.73㎡的患者为参照组，eGFR 60~89、30~59、15~29以及<15 mL/min/1.73㎡或接受透析治疗的患者，其居家出院的校正后OR值分别为0.91、0.85、0.63、0.56，呈现出梯度相关性。该趋势在缺血性卒中与出血性卒中患者中均保持一致。所有卒中患者、缺血性卒中患者及出血性卒中患者的受试者工作特征曲线下面积分别为0.801、0.799、0.815。
卒中患者的居家出院几率随eGFR水平降低呈显著的独立梯度关联；肾功能水平可用于预测卒中患者的居家出院结局。