Beyond the Threshold: Continuous Creatinine Change and Outcomes After Endovascular Thrombectomy for Acute Ischemic Stroke
Ghil Schwarz, Angelo Cascio Rizzo, Gareth Ambler, Pawel Wrona, Agnieszka Slowik, Aleksandra Bodzioch, Mohamed F. Doheim, Alhamza R. Al-Bayati, Raul G. Nogueira, Ana Paiva Nunes, Patricia Ferreira, Matteo Paolucci, Andrea Zini, Luigi Simonetti, Norbert Leško, Jakub Fedorko, Zuzana Gdovinová, Luca Scarcia, Erwah Kalsoum, Firas Farhat, Morin Beyeler, Adnan Mujanovic, Marcel Arnold, Torcato Meira, Marta Morais, Leonor Francisco, Marcin Wiącek, Paulina Pudło, Halina Bartosik-Psujek, Patricia Calleja, Fernando Ostos, David Seoane, Negrila Anca, Razvan Alexandru Radu, Cristina Tiu, Sami Al Kasab, Ahmad Abu Qdais, Imad Samman Tahhan, Oscar Ayo-Martin, Francisco Hernández-Fernández, Maria Paya, Juan David Molina-Nevo, Beata Maria Labuz-Roszak, Danilo Toni, Karolina Moszko, Mateusz Łukasz Roszak, Manuela De Michele, Elena Barrile, Prasanna Eswaradass, Margaret L. Houghton, Tiffany Barkley, Amir Ali, Jelle Demeestere, Wayne Martin Bauknight, Sunil Anil Sheth, Louise Maes, Anke Wouters, João Pedro Marto, José Blazer Costa, Nicola Davide Loizzo, Andrea Romi, Carmelo Tiberio Currò, Piotr Luchowski, Maksymilian Seweryn, Konrad Rejdak, Piers Klein, Mohamad Abdalkader, Valentina Saia, Antioco Sanna, Tiziana Tassinari, Maurizio Acampa, Francesca Rosini, Rossana Tassi, Marta Ewa Bilik, Anna Maria Bandzarewicz-Samcik, Jiangyong Min, Naser HajAissa, Marilena Mangiardi, Sabrina Anticoli, Enrico Pampana, Carlos Hervás-Testal, Ricardo Rigual, Blanca Fuentes, Davide Strambo, Carl Manuata Tetaria, Guillaume Saliou, Andrea Salvatore Caramma, Davide Maimone, Pier Andrea Rizzo, Marco Moci, Irene Scala, Antonio Cruz-Culebras, Rocío Vera Lechuga, Sebastian Garcia Madrona, Giovanni Merlino, Mariarosaria Valente, Arianna Todesco, Manuel Bolognese, Lehel-Barna Lakatos, Grzegorz Marek Karwacki, Paolo Candelaresi, Vincenzo Andreone, Carlo Maurea, Roberto Tarletti, Angelica Mele, Antonio Ciacciarelli, Michele Alessiani, Gabriella Monteforte, David Pakizer, Martin Roubec, David Školoudík, Fenne Vandervorst, Sylvie De Raedt, Martijn Verdam, Josef Bartoš, Martin Šrámek, Valentina Mazzoleni, Luca Quilici, Dario Alimonti, Jessica Moller, Ilaria Maestrini, Marina Diomedi, Giordano Lacidogna, Osama O. Zaidat, Eugene Lin, Mohammad AlMajali, Claudio Baracchini, Matteo Zaccagnino, Federica Viaro, Alessandro Pezzini, Giulia Avola, Chiara Ferraro, Milena Świtońska, Paulina Sobieszak-Skura, Grzegorz Meder, Lukas Mayer-Suess, Michael Knoflach, Elke Ruth Gizewski, Matthew R Common, Patrick Nicholson, Sarah Power, Marta Małgorzata Nowakowska-Kotas, Michał Pula, Maciej Guzinski, Soledad Pérez Sánchez, Joan Montaner, Alexandra Sevilla Bravo, Simona Marcheselli, Francesca Vodret, Costanza Rapillo, Liliana Pereira, Miguel Rodrigues, Adam Jaros, Martin Kovar, Jan Vojik, Gloria Valcamonica, Serena Gallo Cassarino, Alessandra Cardillo, Marco Petruzzellis, Silvia Grimaldi, Nicola Marrone, Ameer E. Hassan, Samantha Miller, Mohammad W. Khasawneh, Valentina Poretto, Simone Tonello, Saverio Tollot, Aleksander Dębiec, Jacek Staszewski, Adam Stepien, Francisco Bernardo, Jorge Ferrao, Marialuisa Zedde, Rosario Pascarella, Alessandra Sanna, Rossella Meloni, Kati Delibas, Simona Sacco, Maria Grazia Vittorini, Raffaele Ornello, Marina Mannino, Valeria Terruso, Marco Filizzolo, Emily Hall, Christine Roffe, Małgorzata Dorobek, Justyna Zielinska-Turek, Giuseppe Scopelliti, Leonardo Pantoni, Guglielmo Carlo Pero, Antonio Macera, Amedeo Cervo, Simone Bellavia, Marco Longoni, Mine Sezgin, Yavuz Dilmen, Esme Ekizoglu, Georgios Tsivgoulis, Aikaterini Theodorou, Vlad Eugen Tiu, Cristina Aura Panea, Simona Petrescu, Mariangela Piano, Thanh N. Nguyen, Maria SessaBACKGROUND:
Contrast-associated acute kidney injury (CA-AKI) after endovascular thrombectomy (EVT) worsens outcomes in acute ischemic stroke, but threshold-based definitions do not capture prognostic information from subthreshold changes. We tested whether early creatinine change within 48 hours of EVT conveys graded prognostic information beyond dichotomous CA-AKI.
METHODS:
We performed a secondary analysis of the CAN-REST (Contrast-Associated Nephropathy After Endovascular Stroke Treatment; REGISTRATION: URL:
RESULTS:
Greater creatinine worsening within 48 hours of EVT was independently associated with an unfavorable 90-day modified Rankin Scale shift (adjusted common odds ratio per 1-unit log-ratio increase, 1.48 [95% CI, 1.07–2.04]; linear) and in-hospital mortality (nonlinear dose-response, of larger magnitude). A 10% increase in creatinine at 48 hours—well below Kidney Disease: Improving Global Outcomes threshold—was associated with worse functional outcome (adjusted common odds ratio, 1.04 [95% CI, 1.01–1.07]) and death (adjusted odds ratio, 1.22 [95% CI, 1.13–1.32]); a 10% decrease in creatinine at 48 hours was associated with lower odds of both outcomes (adjusted common odds ratio, 0.96 [95% CI, 0.93–0.99] and 0.74 [95% CI, 0.65–0.86]). The functional-outcome association concentrated at upper modified Rankin Scale cut-points (severe disability, death); effect modification by baseline renal function was not significant.
CONCLUSIONS:
Early creatinine change after EVT conveys graded, outcome-specific prognostic information extending below formal CA-AKI thresholds, with a dose-response detectable at changes as modest as ±10%, complementing binary CA-AKI as a framework for post-EVT renal risk assessment.
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