Study on Acute Kidney Injury in Patients with Spontaneous Intracerebral Hemorrhage

an Overview from a Tertiary Care Hospital in South India

Marzieh Ansaritoroghi, Shankar Prasad Nagaraju, Rajesh Parameshwaran Nair, Vinod Kumar, Lakshman I. Kongwad, Ravindra Prabhu Attur, Girish Menon Ramachandran, Ajay Hegde

Research output: Contribution to journalArticle

Abstract

Introduction: Acute kidney injury (AKI) is an independent risk factor for adverse clinical outcomes in patients with hemorrhagic stroke. There is limited data regarding the occurrence and impact of AKI in the setting of spontaneous intracerebral hemorrhage (SICH). Considering this, we sought to determine the incidence and risk factors for AKI in patients with SICH and to determine the role of AKI on SICH mortality in our population. Materials and Methods: This is a retrospective analysis of the data recorded in the stroke registry maintained by the Department of Neurosurgery, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education after ethical committee clearance. Information regarding clinical features, demographics, laboratory data, prescribing patterns, and the use of contrast-mediated imaging were collected. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Logistic multivariate regression was used to determine predictors of AKI. Analysis of variance was used to measure the effect of AKI on SICH outcome. Results: Of 316 patients with SICH admitted to the hospital, 20% of patients developed AKI. It was found that risk factors for AKI were lower baseline estimated glomerular filtration rate (odds ratio, 1.60; 95% confidence interval, 1.21 SICH 2.2; P < 0.001) and infectious complications (odds ratio, 3.37; 95% confidence interval, 1.9–5.7; P < 0.001). The incidence of 30 days’ mortality was higher in the group with AKI (14% vs. 5.5%). There was a significant association between AKI severity and short-term mortality (P < 0.001). Patients with AKI had a lower Glasgow Coma Scale on admission (11.81 ± 3.17 vs. 10.83 ± 3.2) and discharge (12.44 ± 3.44 vs. 10.38 ± 3.2) compared to patients without AKI (P < 0.001). Greater severity of AKI was associated with worse neurologic outcome (P < 0.001). Discussion: Various studies in literature have evaluated the incidence of AKI after a stroke episode. The incidence of AKI was ranging from 8%–21% in those studies. In our study, we found that 20% of SICH patients developed AKI. The incidence of AKI in our study falls along the spectrum described in these previous studies. Conclusions: AKI is a common complication of SICH. Lower estimated glomerular filtration rate at admission and infections were the significant risk factors. Patients with AKI had poor neurologic outcome and higher mortality and it increased with the severity of AKI.

Original languageEnglish
JournalWorld Neurosurgery
DOIs
Publication statusAccepted/In press - 01-01-2019

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Cerebral Hemorrhage
Tertiary Healthcare
Acute Kidney Injury
Tertiary Care Centers
India
Incidence
Mortality
Stroke
Glomerular Filtration Rate
Nervous System
Odds Ratio
Confidence Intervals
Glasgow Coma Scale

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Ansaritoroghi, Marzieh ; Nagaraju, Shankar Prasad ; Nair, Rajesh Parameshwaran ; Kumar, Vinod ; Kongwad, Lakshman I. ; Attur, Ravindra Prabhu ; Ramachandran, Girish Menon ; Hegde, Ajay. / Study on Acute Kidney Injury in Patients with Spontaneous Intracerebral Hemorrhage : an Overview from a Tertiary Care Hospital in South India. In: World Neurosurgery. 2019.
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title = "Study on Acute Kidney Injury in Patients with Spontaneous Intracerebral Hemorrhage: an Overview from a Tertiary Care Hospital in South India",
abstract = "Introduction: Acute kidney injury (AKI) is an independent risk factor for adverse clinical outcomes in patients with hemorrhagic stroke. There is limited data regarding the occurrence and impact of AKI in the setting of spontaneous intracerebral hemorrhage (SICH). Considering this, we sought to determine the incidence and risk factors for AKI in patients with SICH and to determine the role of AKI on SICH mortality in our population. Materials and Methods: This is a retrospective analysis of the data recorded in the stroke registry maintained by the Department of Neurosurgery, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education after ethical committee clearance. Information regarding clinical features, demographics, laboratory data, prescribing patterns, and the use of contrast-mediated imaging were collected. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Logistic multivariate regression was used to determine predictors of AKI. Analysis of variance was used to measure the effect of AKI on SICH outcome. Results: Of 316 patients with SICH admitted to the hospital, 20{\%} of patients developed AKI. It was found that risk factors for AKI were lower baseline estimated glomerular filtration rate (odds ratio, 1.60; 95{\%} confidence interval, 1.21 SICH 2.2; P < 0.001) and infectious complications (odds ratio, 3.37; 95{\%} confidence interval, 1.9–5.7; P < 0.001). The incidence of 30 days’ mortality was higher in the group with AKI (14{\%} vs. 5.5{\%}). There was a significant association between AKI severity and short-term mortality (P < 0.001). Patients with AKI had a lower Glasgow Coma Scale on admission (11.81 ± 3.17 vs. 10.83 ± 3.2) and discharge (12.44 ± 3.44 vs. 10.38 ± 3.2) compared to patients without AKI (P < 0.001). Greater severity of AKI was associated with worse neurologic outcome (P < 0.001). Discussion: Various studies in literature have evaluated the incidence of AKI after a stroke episode. The incidence of AKI was ranging from 8{\%}–21{\%} in those studies. In our study, we found that 20{\%} of SICH patients developed AKI. The incidence of AKI in our study falls along the spectrum described in these previous studies. Conclusions: AKI is a common complication of SICH. Lower estimated glomerular filtration rate at admission and infections were the significant risk factors. Patients with AKI had poor neurologic outcome and higher mortality and it increased with the severity of AKI.",
author = "Marzieh Ansaritoroghi and Nagaraju, {Shankar Prasad} and Nair, {Rajesh Parameshwaran} and Vinod Kumar and Kongwad, {Lakshman I.} and Attur, {Ravindra Prabhu} and Ramachandran, {Girish Menon} and Ajay Hegde",
year = "2019",
month = "1",
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doi = "10.1016/j.wneu.2018.12.018",
language = "English",
journal = "World Neurosurgery",
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Study on Acute Kidney Injury in Patients with Spontaneous Intracerebral Hemorrhage : an Overview from a Tertiary Care Hospital in South India. / Ansaritoroghi, Marzieh; Nagaraju, Shankar Prasad; Nair, Rajesh Parameshwaran; Kumar, Vinod; Kongwad, Lakshman I.; Attur, Ravindra Prabhu; Ramachandran, Girish Menon; Hegde, Ajay.

In: World Neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Study on Acute Kidney Injury in Patients with Spontaneous Intracerebral Hemorrhage

T2 - an Overview from a Tertiary Care Hospital in South India

AU - Ansaritoroghi, Marzieh

AU - Nagaraju, Shankar Prasad

AU - Nair, Rajesh Parameshwaran

AU - Kumar, Vinod

AU - Kongwad, Lakshman I.

AU - Attur, Ravindra Prabhu

AU - Ramachandran, Girish Menon

AU - Hegde, Ajay

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Acute kidney injury (AKI) is an independent risk factor for adverse clinical outcomes in patients with hemorrhagic stroke. There is limited data regarding the occurrence and impact of AKI in the setting of spontaneous intracerebral hemorrhage (SICH). Considering this, we sought to determine the incidence and risk factors for AKI in patients with SICH and to determine the role of AKI on SICH mortality in our population. Materials and Methods: This is a retrospective analysis of the data recorded in the stroke registry maintained by the Department of Neurosurgery, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education after ethical committee clearance. Information regarding clinical features, demographics, laboratory data, prescribing patterns, and the use of contrast-mediated imaging were collected. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Logistic multivariate regression was used to determine predictors of AKI. Analysis of variance was used to measure the effect of AKI on SICH outcome. Results: Of 316 patients with SICH admitted to the hospital, 20% of patients developed AKI. It was found that risk factors for AKI were lower baseline estimated glomerular filtration rate (odds ratio, 1.60; 95% confidence interval, 1.21 SICH 2.2; P < 0.001) and infectious complications (odds ratio, 3.37; 95% confidence interval, 1.9–5.7; P < 0.001). The incidence of 30 days’ mortality was higher in the group with AKI (14% vs. 5.5%). There was a significant association between AKI severity and short-term mortality (P < 0.001). Patients with AKI had a lower Glasgow Coma Scale on admission (11.81 ± 3.17 vs. 10.83 ± 3.2) and discharge (12.44 ± 3.44 vs. 10.38 ± 3.2) compared to patients without AKI (P < 0.001). Greater severity of AKI was associated with worse neurologic outcome (P < 0.001). Discussion: Various studies in literature have evaluated the incidence of AKI after a stroke episode. The incidence of AKI was ranging from 8%–21% in those studies. In our study, we found that 20% of SICH patients developed AKI. The incidence of AKI in our study falls along the spectrum described in these previous studies. Conclusions: AKI is a common complication of SICH. Lower estimated glomerular filtration rate at admission and infections were the significant risk factors. Patients with AKI had poor neurologic outcome and higher mortality and it increased with the severity of AKI.

AB - Introduction: Acute kidney injury (AKI) is an independent risk factor for adverse clinical outcomes in patients with hemorrhagic stroke. There is limited data regarding the occurrence and impact of AKI in the setting of spontaneous intracerebral hemorrhage (SICH). Considering this, we sought to determine the incidence and risk factors for AKI in patients with SICH and to determine the role of AKI on SICH mortality in our population. Materials and Methods: This is a retrospective analysis of the data recorded in the stroke registry maintained by the Department of Neurosurgery, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education after ethical committee clearance. Information regarding clinical features, demographics, laboratory data, prescribing patterns, and the use of contrast-mediated imaging were collected. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Logistic multivariate regression was used to determine predictors of AKI. Analysis of variance was used to measure the effect of AKI on SICH outcome. Results: Of 316 patients with SICH admitted to the hospital, 20% of patients developed AKI. It was found that risk factors for AKI were lower baseline estimated glomerular filtration rate (odds ratio, 1.60; 95% confidence interval, 1.21 SICH 2.2; P < 0.001) and infectious complications (odds ratio, 3.37; 95% confidence interval, 1.9–5.7; P < 0.001). The incidence of 30 days’ mortality was higher in the group with AKI (14% vs. 5.5%). There was a significant association between AKI severity and short-term mortality (P < 0.001). Patients with AKI had a lower Glasgow Coma Scale on admission (11.81 ± 3.17 vs. 10.83 ± 3.2) and discharge (12.44 ± 3.44 vs. 10.38 ± 3.2) compared to patients without AKI (P < 0.001). Greater severity of AKI was associated with worse neurologic outcome (P < 0.001). Discussion: Various studies in literature have evaluated the incidence of AKI after a stroke episode. The incidence of AKI was ranging from 8%–21% in those studies. In our study, we found that 20% of SICH patients developed AKI. The incidence of AKI in our study falls along the spectrum described in these previous studies. Conclusions: AKI is a common complication of SICH. Lower estimated glomerular filtration rate at admission and infections were the significant risk factors. Patients with AKI had poor neurologic outcome and higher mortality and it increased with the severity of AKI.

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