Pre-Existing Renal Failure Increases In-Hospital Mortality in Patients with Intracerebral Hemorrhage

Rakesh Khatri; Mohammad Rauf Afzal; Mohtashim Arbaab Qureshi; Alberto Maud; Dou Huanyu; Gustavo Jose Rodriguez

doi:10.1016/j.jstrokecerebrovasdis.2018.07.036

Pre-Existing Renal Failure Increases In-Hospital Mortality in Patients with Intracerebral Hemorrhage

J Stroke Cerebrovasc Dis. 2019 Feb;28(2):237-242. doi: 10.1016/j.jstrokecerebrovasdis.2018.07.036. Epub 2018 Nov 14.

Authors

Rakesh Khatri¹, Mohammad Rauf Afzal², Mohtashim Arbaab Qureshi², Alberto Maud², Dou Huanyu², Gustavo Jose Rodriguez²

Affiliations

¹ Department of Neurology, Texas Tech University Health Sciences Center, Elpaso, Texas. Electronic address: rakesh.khatri@ttuhsc.edu.
² Department of Neurology, Texas Tech University Health Sciences Center, Elpaso, Texas.

PMID: 30448090
DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.036

Abstract

Background: To determine the clinical outcome for intracerebral hemorrhage (ICH) patients with pre-existing renal failure in the United States.

Methods: We analyzed the data from Nationwide Inpatient Sample (2008-2012) for all ICH patients with or without pre-existing renal failure. Patients were identified using the International Classification of Disease, Ninth Revision, Clinical Modification codes. Baseline characteristics, in-hospital complications, and exposure to invasive procedures were compared between groups. Discharge outcomes (mortality, minimal disability, and moderate-to-severe disability) were compared between the two groups, before and after adjusting for the presence of other medical comorbidities, in-hospital complications, and exposure to invasive procedures.

Results: Of the 328,728 patients with ICH, 36,067 (11.8%) had pre-existing renal failure as a comorbidity. There were higher rates for in-hospital complications like myocardial infarction (3.5% versus 1.9%, P ≤ .0001), sepsis (5.4% versus 3.0%, P ≤ .0001), pneumonia (7.1% versus 5.3%, P ≤ .0001), deep venous thrombosis (1.6% versus 1.2%, P = .0041), urinary tract infections (16.9% versus 15.1%, P = .0101), and gastrointestinal bleeding (0.4% versus 0.2%, P ≤ .0154), longer hospital stay (9.4 ± 14.4 versus 7.7 ± 11.4; P < .0001), and higher mean hospital charges ($86497.9 ± 131708.1 versus $69583.4 ± 110629.1; P < .0001) in patients with pre-existing renal failure . The in-hospital mortality was also higher among patients with pre-existing renal failure as comorbidity in both univariate (26.4% versus 25.3 %, P = .0010) and multivariate analysis (odds ratio [OR] = 1.124 [1.042-1.213], P = .0025). There was no statistically significant difference for in terms of moderate to severe disability between 2 groups (OR = 1.030 [0.962-1.104], P value: .3953 in multivariate analysis when analysis was limited to alive patients.

Conclusions: Patients with ICH, who present with pre-existing renal failure, have higher rates of in-hospital mortality but not for disability, the difference remained significant after adjusting for the presence of other medical comorbidities, in-hospital complications or exposure to invasive procedures.

Keywords: In-hospital mortality; Intracerebral hemorrhage; Nationwide Inpatient Sample (NIS); Renal failure.

Publication types

Observational Study

MeSH terms

Aged
Aged, 80 and over
Cerebral Hemorrhage / diagnosis
Cerebral Hemorrhage / mortality*
Cerebral Hemorrhage / physiopathology
Cerebral Hemorrhage / therapy
Comorbidity
Databases, Factual
Disability Evaluation
Female
Hospital Mortality*
Humans
Kidney / physiopathology*
Length of Stay
Male
Middle Aged
Patient Admission
Patient Discharge
Renal Insufficiency / diagnosis
Renal Insufficiency / mortality*
Renal Insufficiency / physiopathology
Renal Insufficiency / therapy
Risk Factors
Time Factors
United States / epidemiology