Abstract Body: Background: The effect of renal dysfunction on early infarct growth rate (IGR) in anterior circulation large vessel occlusion (ACLVO) stroke is not well studied. This study aimed to explore the association between creatinine-based biomarkers of renal dysfunction, fast or slow progressor phenotypes of infarct growth in ACLVO stroke, and related clinical outcomes.
Methods: This retrospective study examined patients with acute intracranial internal carotid artery or middle cerebral artery M1 occlusions admitted between 2014 and 2019. Patients were included if they received baseline MRI or CTP on presentation within 24 hours after stroke onset. Infarct growth rate (IGR) was determined by ischemic core volume divided by time from stroke onset to imaging and used to stratify fast progressors (IGR ≥10 mL/h) and slow progressors (IGR < 10 mL/h). Renal dysfunction was assessed based on serum creatinine and estimated glomerular filtration rate (eGFR) on presenting laboratories. Logistic regression models, adjusted for significant covariates, identified independent associations between renal dysfunction biomarkers, progressor status, and clinical outcomes based on modified Rankin Scale (mRS) at 90 days.
Results: Among 230 patients with ACLVO, 29% were fast progressors, with median serum creatinine levels higher than slow progressors (1.1 vs. 0.9 mg/dL, p < 0.05) and lower median eGFR (66.2 vs. 69.0 mL/min/1.73m2, p < 0.05). Elevated creatinine (≥1.2 mg/dL) was independently associated with fast progressor status (adjusted OR 2.37, 95% CI 1.18-4.77), worse 90-day mRS (adjusted OR 1.88, 95% CI 1.01-3.51) and mortality (adjusted OR 2.57, 95% CI 1.14-5.79). Reduced eGFR (<60 mL/min/1.73m2) was independently associated with fast progressor status (adjusted OR 2.38, 95% CI 1.14-4.94), but not with 90-day mRS or mortality.
Conclusion: Serum creatinine-based biomarkers of renal dysfunction were associated with faster progressor phenotype of ACLVO stroke, higher mRS, and mortality at 90 days. These findings suggest that point-of-care creatinine measurements may help identify patients with rapid ischemic core growth and highest risk for worse clinical outcomes on first emergency contact, aiding in the inter-facility transfer for high-risk patients.