Abstract TP378: Elevated Creatinine at Presentation is Associated With Higher In-Hospital Mortality Among Acute Ischemic Stroke Patients

Abstract

Introduction: Impaired renal function is an established predictor of survival in the general population, and in patients with myocardial infarction or heart failure. Recent evidence suggests that reduced kidney function may predict mortality after acute ischemic stroke (AIS). We sought to evaluate if elevated creatinine (Cr >1.5mg/dL) at presentation is associated with higher in-hospital mortality in AIS patients. Methods: Using GWTG stroke registry data from three large comprehensive stroke centers in Northeast, South and West, we analyzed 9,472 consecutive stroke admissions from 02/2002 - 06/2018 with documented Cr. Patient were divided into Group 1: normal renal function (Cr ≤1.5) and Group 2: elevated Creatinine (>1.5). Chi-square was used for categorial data, T-Test for parametric continuous and Wilcoxon for non-parametric continuous variables. Multiple regression analysis was used to identify associations. Results: Of the 9,472 AIS patients, 977 (10.3%) had baseline Cr > 1.5. Patients with elevated Cr were older, more often male, less often White and had higher frequency of hypertension, diabetes, hyperlipidemia, CAD/MI, heart failure and atrial fibrillation, and had increased pneumonia during the incident admission. They had higher NIHSS at presentation and underwent IV tPA +- endovascular therapy more often than patients with Cr ≤ 1.5. The in-patient mortality was twice as high in Group 2 than Group 1 (OR 1.17 per 1.0 mg/dL increase in Cr (95% CI 1.10, 1.30; p<0.001)). Renal impairment (Cr > 1.5) remained a strong predictor for mortality in multivariable regression (OR 1.91 (95% CI 1.47, 2.48; p<0.001)). Conclusion: Patients with elevated Cr at presentation were found to have higher in-hospital mortality, suggesting an independent association between renal function and mortality after AIS. Further research is warranted, especially since many of these patients are exposed to nephrotoxic contrast agents.