Proteinuria's Influence on Clinical Outcomes and Prognostic Accuracy in Acute Ischaemic Stroke Patients Undergoing Reperfusion Therapy: A Comprehensive Meta-Analysis

Aim: Proteinuria commonly accompanies acute ischaemic stroke (AIS) patients undergoing reperfusion therapies such as intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). Understanding its influence on outcomes is crucial for prognosis and optimising management strategies. This study aims to elucidate proteinuria's role in mediating outcomes among reperfusion-treated patients. Methods: Through a random-effects meta-analysis, we analysed data to assess the association of proteinuria with functional outcomes, symptomatic intracerebral haemorrhage (sICH) and mortality. A total of 33 140 patients were included in the meta-analysis. Results: Proteinuria demonstrated a pooled prognostic sensitivity of 58% (95% CI: [48%; 67%]; p < 0.001) for poor functional outcomes at 90 days. It was linked with increased odds of unfavourable functional outcome at 90 days in both IVT (OR 2.27; 95% CI: [1.95; 2.66]; p < 0.001) and EVT (OR 2.57; 95% CI: [2.16; 3.05]; p < 0.001) groups. Furthermore, it was associated with increased odds of 90-day mortality in IVT-treated patients (OR 2.31; 95% CI: [1.76; 3.02]; p < 0.001), while EVT-treated patients exhibited increased odds of in-hospital mortality (OR 2.71; 95% CI: [1.22; 6.04]; p < 0.05). Conclusions: The clinical significance of proteinuria is underscored by its impact on outcomes for AIS patients receiving reperfusion treatments. This awareness may guide individualised treatment by considering the intricate interplay between kidney function and its correlation with stroke. Consequently, this has the potential to improve prognosis and overall outcomes in AIS therapy.