Effects of the blood urea nitrogen to creatinine ratio on haemorrhagic transformation in AIS patients with diabetes mellitus

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Abstract

Background

The effect of the blood urea nitrogen (BUN) to creatinine (Cr) ratio (henceforth BUN/Cr) on haemorrhagic transformation (HT) of acute ischaemic stroke (AIS) patients is unclear.

Methods

AIS patients in the West China Hospital, Sichuan University, Chengdu, China, admitted within seven days from stroke onset (2012–2016) were included in the study. Baseline data, including BUN and Cr levels, were collected. The outcome was defined as HT during hospitalization.

Results

In this study, 1738 participants with an average age of 62.7 ± 14.0 years were included. After adjusting potential confounders (age, blood platelet, albumin, stroke severity, triglycerides and low-density lipoprotein [LDL]), multivariate logistic regression analyses indicated that BUN/Cr is independently associated with HT. The nonlinear relation between BUN/Cr and HT was explored in a dose-dependent manner, with an apparent inflection point of 30.71. On the left and right sides of the inflection point, the odds ratio (OR) and 95% confidence interval (CI) were 1.05 (1.02–1.08) and 0.96 (0.88–1.05), respectively. Interaction between BUN/Cr and diabetes mellitus (DM) and HT ( P for interaction = 0.0395) was noted. BUN/Cr showed positive correlation with HT in DM patients (OR = 1.07; 95% CI: [1.02, 1.12]) but no significant relationship with HT in patients without DM.

Conclusion

BUN/Cr is significantly associated with HT in AIS patients in a linear fashion, with an apparent cut point demarcating the HT difference. When the patients have DM, BUN/Cr is positively correlated with HT. These results support a revision in how we anticipate the prognosis for AIS patients.

Electronic supplementary material

The online version of this article (10.1186/s12883-019-1290-x) contains supplementary material, which is available to authorized users.

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Most cited references 39

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Cerebrovascular disease in the community: results of a WHO collaborative study.

K Aho, P Harmsen, S Hatano … (1980)

In a cooperative study coordinated by WHO, stroke was registered between 1971 and 1974 in 17 centres both in developing and developed countries. A common operating protocol was used to obtain comparable data. Age-adjusted incidence of stroke shows moderate geographical variations, cerebrovascular accidents being common in all the contrasting populations studied in various parts of the world. Data were also obtained on the types of management of stroke patients, their survival rates, and functional prognosis. Control of hypertension, although known to be effective in the prevention of stroke, seemed to be insufficient in most countries. It is concluded that stroke registers may be used as a source of information for the planning and implementation of stroke control programmes in the community.

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Phenylpropanolamine and the risk of hemorrhagic stroke.

M. Brass, Mark E. Feldmann, J Wilterdink … (2000)

Phenylpropanolamine is commonly found in appetite suppressants and cough or cold remedies. Case reports have linked the use of products containing phenylpropanolamine to hemorrhagic stroke, often after the first use of these products. To study the association, we designed a case-control study. Men and women 18 to 49 years of age were recruited from 43 U.S. hospitals. Eligibility criteria included the occurrence of a subarachnoid or intracerebral hemorrhage within 30 days before enrollment and the absence of a previously diagnosed brain lesion. Random-digit dialing identified two matched control subjects per patient. There were 702 patients and 1376 control subjects. For women, the adjusted odds ratio was 16.58 (95 percent confidence interval, 1.51 to 182.21; P=0.02) for the association between the use of appetite suppressants containing phenylpropanolamine and the risk of a hemorrhagic stroke and 3.13 (95 percent confidence interval, 0.86 to 11.46; P=0.08) for the association with the first use of a product containing phenylpropanolamine. All first uses of phenylpropanolamine involved cough or cold remedies. For men and women combined, the adjusted odds ratio was 1.49 (95 percent confidence interval, 0.84 to 2.64; P=0.17) for the association between the use of a product containing phenylpropanolamine and the risk of a hemorrhagic stroke, 1.23 (95 percent confidence interval, 0.68 to 2.24; P=0.49) for the association with the use of cough or cold remedies that contained phenylpropanolamine, and 15.92 (95 percent confidence interval, 1.38 to 184.13; P=0.03) for the association with the use of appetite suppressants that contained phenylpropanolamine. An analysis in men showed no increased risk of a hemorrhagic stroke in association with the use of cough or cold remedies containing phenylpropanolamine. No men reported the use of appetite suppressants. The results suggest that phenylpropanolamine in appetite suppressants, and possibly in cough and cold remedies, is an independent risk factor for hemorrhagic stroke in women.

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Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: safe Implementation of Treatments in Stroke (SITS) symptomatic intracerebral hemorrhage risk score.

Nils Wahlgren, Gary Ford, Emma K Lees … (2012)

Symptomatic intracerebral hemorrhage (SICH) is a serious complication in patients with acute ischemic stroke treated with intravenous thrombolysis. We aimed to develop a clinical score that can easily be applied to predict the risk of SICH. We analyzed data from 31 627 patients treated with intravenous alteplase enrolled in the Safe Implementation of Treatments in Stroke (SITS) International Stroke Thrombolysis Register. The outcome measure was SICH per the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition: a Type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale score of ≥ 4 points or death. Univariate risk factors associated with the outcome were entered into a logistic regression model after stratification of continuous variables. Adjusted ORs for the independent risk factors were converted into points, which were summated to produce a risk score. We identified 9 independent risk factors for SICH: baseline National Institutes of Health Stroke Scale, serum glucose, systolic blood pressure, age, body weight, stroke onset to treatment time, aspirin or combined aspirin and clopidogrel, and history of hypertension. The overall rate of SICH was 1.8%. The risk score ranged from 0 to 12 points and showed a >70-fold graded increase in the rate of SICH for patients with a score ≥ 10 points (14.3%) compared with a score of 0 point (0.2%). The prognostic discriminating capability by C statistic was 0.70. The SITS SICH risk score predicts large cerebral parenchymal hemorrhages associated with severe clinical deterioration. The score could aid clinicians to identify patients at high as well as low risk of SICH after intravenous alteplase.

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Author and article information

Contributors

Bo Wu: dragonwb@126.com

Ming Liu: wyplmh@hotmail.com

Journal

Journal ID (nlm-ta): BMC Neurol

Journal ID (iso-abbrev): BMC Neurol

Title: BMC Neurology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2377

Publication date (Electronic): 13 April 2019

Publication date PMC-release: 13 April 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 63

Affiliations

[1 ]ISNI 0000 0001 0807 1581, GRID grid.13291.38, Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, , Sichuan University, ; Chengdu, Sichuan China

[2 ]ISNI 0000 0001 0807 1581, GRID grid.13291.38, Department of Urology, Institute of Urology, West China Hospital, , Sichuan University, ; Chengdu, Sichuan China

[3 ]ISNI 0000 0001 0807 1581, GRID grid.13291.38, Center of Biomedical big data, West China Hospital, , Sichuan University, ; Chengdu, Sichuan China

[4 ]ISNI 0000 0001 2256 9319, GRID grid.11135.37, Department of Epidemiology and Biostatistics, School of Public Health, , Peking University, ; Beijing, China

Article

Publisher ID: 1290

DOI: 10.1186/s12883-019-1290-x

PMC ID: 6463662

PubMed ID: 30987606

SO-VID: a15f9a7b-cd1a-4f28-8c3b-7045a0438697

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 31 July 2018

Date accepted : 31 March 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 81620108009

Award ID: 81671146

Award Recipient : Bo Wu Ming Liu

Funded by: FundRef http://dx.doi.org/10.13039/501100002855, Ministry of Science and Technology of the People's Republic of China;

Award ID: 2016YFC1300500-505

Award Recipient : Ming Liu

Custom metadata

ScienceOpen disciplines: Neurology

Keywords: blood urea nitrogen,creatinine,ischaemic stroke,haemorrhagic transformation,nonlinear relationship

Data availability:

ScienceOpen disciplines: Neurology

Keywords: blood urea nitrogen, creatinine, ischaemic stroke, haemorrhagic transformation, nonlinear relationship

Effects of the blood urea nitrogen to creatinine ratio on haemorrhagic transformation in AIS patients with diabetes mellitus

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Background

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Electronic supplementary material

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Stroke MRI

Most cited references 39

Cerebrovascular disease in the community: results of a WHO collaborative study.

Phenylpropanolamine and the risk of hemorrhagic stroke.

Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: safe Implementation of Treatments in Stroke (SITS) symptomatic intracerebral hemorrhage risk score.

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