1085: HYPERCHLOREMIA AND ACUTE KIDNEY INJURY IN PATIENTS WITH NONTRAUMATIC INTRACRANIAL HEMORRHAGE

Abstract

Introduction: Hypertonic saline (HTS) is commonly used in patients with non-traumatic intracranial hemorrhage (ICH) as a prophylactic and therapeutic option for intracranial hypertension and/or cerebral edema. Hyperchloremia is often resulted an adverse event due to the accompanying chloride load. Among patients with subarachnoid hemorrhage, traumatic brain injury, and acute ischemic stroke, previous literature has demonstrated an association between hyperchloremia and acute kidney injury (AKI) incidence, length of stay (LOS), and even mortality. We sought to investigate this relationship in patients with non-traumatic ICH. Methods: This was a single-center, retrospective, cohort study comparing patients with and without hyperchloremia in the first 7 days of hospitalization. This was defined as a serum chloride level above 115 mEq/L. Primary outcome was incidence of AKI in the first 10 days of hospitalization, defined by having met any of either AKIN or RIFLE criteria. Secondary outcomes included ICU and hospital LOS, disposition status, and in-hospital mortality. All adult patients with non-traumatic ICH were included. Those who had CKD stage 3 or higher, baseline SCr > 2 mg/dL or chloride > 115 mEq/L, mannitol administration, and LOS < 72 hours were excluded. Results: A total of 133 patients were analyzed, 54 of which were in the hyperchloremia group. Baseline characteristics were similar between groups, except for chloride, Modified Early Warning score (MEWS), and ICH score. Incidence of AKI was found in 32.9% and 35.2% of the non-hyperchloremia and hyperchloremia groups, respectively (p=0.785). Patients with hyperchloremia had longer ICU LOS (7 vs. 5 days, p=0.006), lower rate of independent disposition (18.5% vs. 44.3%, p=0.001), and higher rate of mortality (38.9% vs. 15.2%, p=0.002). A logistic regression analysis was run to predict mortality risk using AKI, hyperchloremia, ICH score, and MEWS. ICH score was the only significant predictor of mortality (OR 2.25 (95% CI 1.40 -3.64), p=0.01). Conclusions: In non-traumatic ICH patients, we found no significant difference with AKI development between non-hyperchloremia and hyperchloremia groups. Baseline ICH score was predictive of mortality risk. Study limitations were its observational nature and lack of propensity score matching.