Serum creatinine does not improve early classification of ischemic stroke caused by small artery occlusion.

OBJECTIVE

Accurate subtyping of ischemic stroke in the acute setting is a potentially important but very difficult task. Microvascular disease is a systemic disorder, and we hypothesized that impaired renal function, which is most commonly a result of microvascular disease, would correlate with the subtype of small-artery occlusion (SAO) in patients with acute ischemic stroke.

METHODS

This was a retrospective cohort study of consecutive patients with ischemic stroke. Clinical and laboratory data at admission were analyzed and compared with the final determination of stroke subtype. We determined whether serum creatinine level at admission was independently associated with final determination of the SAO stroke subtype.

RESULTS

There was no correlation between elevated baseline creatinine (>/=1.5 mg/dL) and SAO (odds ratio = 0.38, 95% confidence interval 0.01-2.98, P = .38). The most helpful predictor of a final SAO subtype was lacunar syndrome on initial examination, but only in patients with diabetes (positive predictive value = 67%, 95% confidence interval 30%-93%).

CONCLUSIONS

Laboratory evidence of impaired renal function does not aid the early identification of the SAO stroke subtype in patients with acute stroke. In addition, an initial lacunar syndrome only effectively identifies SAO among patients with diabetes, not the general stroke population.