A 5-item prediction rule to identify severe renal dysfunction in patients with acute stroke.

BACKGROUND AND PURPOSE: Although patients with severe renal dysfunction who receive iodinated contrast are at high risk of CIN, contrast-enhanced CT scans are often obtained without prior knowledge of kidney function in patients with acute stroke. We aimed to develop a tool to identify patients with acute stroke at a high risk of CIN in the absence of a recent GFR. MATERIALS AND METHODS: We used the RCSN (9872 patients) and OSA (2544 patients) for our derivation and validation cohort, respectively. A multivariable logistic regression model was performed to develop a predictive tool to identify severe renal dysfunction (defined as a GFR < 30 mL/min/1.73 m(2)). RESULTS: The overall prevalence of severe renal dysfunction was 4.9% and 5.2% in the derivation and validation cohort, respectively. The prediction rule was designed as follows: (age in years) + (5 points for women) + (5 points for history of diabetes mellitus) + (15 points for preadmission insulin use) + (10 points for history of hypertension). The prevalence of severe renal dysfunction is negligible in patients with a total score of ≤70 (≤0.005%-0.7%) but increases with higher Renal Risk Scores (eg, scores 71-80: 2.1%-2.2%; scores 91-100: 6.6%-7.1%; scores 111-120: 15.9%-28.1%). CONCLUSIONS: The Renal Risk Score is a validated tool that helps clinicians select which patients with stroke can safely proceed to contrast-enhanced brain imaging without waiting for laboratory evidence of good renal function.

Ethnicity a risk factor? The relation between ethnicity and large- and small-vessel disease in White people, Black people, and Asians within a hospital-based population.

BACKGROUND: Previous studies suggest that in patients with ischaemic stroke, White people often present with large-vessel and Black people with small-vessel strokes. This study investigates the relation between large- and small-vessel disease, and ethnicity in White, Black, and Asian patients in Amsterdam, The Netherlands. METHODS: In a hospital-based population of 668 patients ethnicity was determined by self-identification. The relation between ethnicity and carotid stenosis, as an indicator of large-vessel disease, was determined using univariate analysis, and adjusted for age, gender, hypertension and smoking. Subsequently the relation between ethnicity and lacunar infarcts, as a manifestation of small-vessel disease, was investigated. RESULTS: The odds ratio for having carotid stenosis, compared to White patients, was 0.55 (0.23-1.33) for Blacks, 0.53 (0.18-1.52) for Asians, and 0.64 (0.14-2.85) for other ethnicities. The adjusted odds ratio for a non-White patient compared to a White patient was 0.44 (0.19-1.02) (P = 0.05). The non-White patients more often presented with lacunar infarcts compared to Whites. CONCLUSION: We found an association between White patients and the presence of carotid artery stenosis. Not only in Black but also in Asian patients the association with carotid artery stenosis was substantially lower. In the non-White population there was an association with lacunar infarcts compared to Whites.