Association between Albuminuria, Glomerular Filtration Rate and Mortality or Recurrence in Stroke Patients

&lt;i&gt;Background/Aims:&lt;/i&gt; In an attempt to find new predictors of stroke prognosis, we evaluated the association of albuminuria (AUr) and the estimated glomerular filtration rate (eGFR) with the recurrence of stroke and mortality. &lt;i&gt;Methods:&lt;/i&gt; We evaluated and followed for at least 7 months patients with first-ever stroke or transient ischemic attack admitted to a prospective cohort from March 2005 to December 2007. We analyzed traditional CV risk factors, albumin-to-creatinine ratio and eGFR (ml/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;) as predictors of mortality or recurrence. &lt;i&gt;Results:&lt;/i&gt; From a total of 185 patients included [57% (104/185) men, 64 ± 13 years], 38 patients suffered from a recurrent stroke or died, with a mean follow-up of 25.1 ± 8.7 months. AUr (≧30 mg/g) was found in 50.2% (93/185), and 38.9% (72/185) presented an eGFR &lt;60. In univariate analysis, age &gt;65 years, eGFR ≤50, atrial fibrillation (AF), no alcohol intake and AUr &gt;17 mg/g were associated with the composite endpoint. In a multivariate analysis, AF and AUr &gt;17 mg/g were independent predictors of the composite endpoints, but eGFR ≤50 was not. &lt;i&gt;Conclusion:&lt;/i&gt; The presence of AUr &gt;17 mg/g is independently associated with death or recurrence after stroke. Further studies should consider the AUr as a predictor for a worse prognosis in these patients.</jats:p

Supplementary Material for: Trends of the Incidence of Ischemic Stroke Thrombolysis over Seven Years and One-Year Outcome: A Population-Based Study in Joinville, Brazil

<b><i>Background:</i></b> In a population-based setting, we aimed to measure the incidence trends of ischemic stroke (IS) thrombolysis, thrombolysis times, proportion of symptomatic intracerebral hemorrhage (sICH), 30-day case fatality and functional outcomes. We also compared the 12-month functional status between thrombolyzed and nonthrombolyzed patients. <b><i>Methods:</i></b> Using data from the Joinville Population-Based Stroke Registry, we prospectively ascertained a cohort of all thrombolyses done in Joinville citizens, Southern Brazil, from 2005 to 2011. For the definition of sICH we used European Cooperative Acute Stroke Study (ECASS) II criteria. <b><i>Results:</i></b> Over 7 years, 6% (220/3,552) of all IS were thrombolyzed. The thrombolysis incidence increased from 1.4 [95% confidence interval (CI), 0.6-2.9] in 2005 to 9.8 (7.3-12.9) per 100,000 population in 2011 (p < 0.0001). The thrombolysis incidence age-adjusted to the world population in 2011 was 11 (8.2-14.3) per 100,000. Only 30% (50/165) were thrombolyzed within 1 h of arrival at hospital. In 7 days, 6.4% (14/220) had sICH and 57% (8/14) of those died. In the 2009-2011 period, a favorable functional outcome [modified Rankin scale (mRS) 0-1] at 12 months among patients who received thrombolysis was more frequent [mRS 0-1; 36% (38/107)] than among patients who did not receive thrombolysis [mRS 0-1; 24% (131/544); p = 0.016]. The logistic regression showed that thrombolyzed IS patients had a more favorable outcome (mRS 0-1; HR 2.13; 95% CI, 1.2-3.7; p < 0.016) than nonthrombolyzed patients. <b><i>Conclusion:</i></b> In a population setting of a middle income country, the thrombolysis incidence and outcomes were similar to those of other well-structured services. After 1 year, patients thrombolyzed in the 4.5-hour time window had a better outcome. More than proportions, rates provide additional information and could be used to benchmark services against others

Supplementary Material for: Trends of Stroke Incidence from 1995 to 2013 in Joinville, Brazil

<b><i>Background:</i></b> Temporal trends on the incidence of stroke and its subtypes could help assess on-going public health policies and point to further targets for action among middle- and low-income countries, where the stroke burden is very high. This study aimed at evaluating longitudinal trends of stroke incidence in Joinville, Brazil. <b><i>Methods:</i></b> We ascertained the incidence of all first-ever strokes occurred in 1995, 2005-2006 and 2012-2013, which were extracted from Joinville Stroke Registry, a prospective epidemiological data bank, launched in 1995. <b><i>Results:</i></b> From 1995 to 2013, the age-adjusted incidence of all strokes decreased 37% (95% CI 32-42). From 2005 to 2013, the haemorrhagic stroke (HS) incidence decreased 60% (95% CI 13-86), ischemic stroke (IS) incidence decreased 15% (95% CI 1-28), and subarachnoid haemorrhage incidence remained stable. The proportion of IS and HS patients with regularly treated hypertension increased by 60% (p = 0.01) and 33% (p = 0.01), respectively. The proportion of IS and HS patients that quit smoking increased 8% (p = 0.03) and 17% (p = 0.03), respectively. <b><i>Conclusions:</i></b> Stroke incidence has been decreasing in Joinville over the last 18 years, more so for HS than IS. Better control of hypertension and tobacco use might explain these findings