Abstract
BackgroundAlthough acute kidney injury (AKI) is a known risk factor for adverse clinical outcomes in patients with spontaneous intracerebral haemorrhage (SICH), little is known about the predisposing factors that contribute to renal failure and short-term prognosis in the setting of SICH already complicated by AKI. In this study, we aimed to identify the renal failure factors in SICH patents with AKI.MethodsFive hundred forty-three patients with SICH complicated by differential severities of AKI who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2016 to December 2018 were retrospectively studied. Logistic regression and receiver operator characteristic (ROC) curve analysis were performed to determine the best predictive and discriminative variables. Multivariate Cox regression analysis was performed to identify prognostic factors for renal recovery.ResultsIn the multivariable adjusted model, we found that hypernatremia, metabolic acidosis, elevated serum creatine kinase, hyperuricaemia, proteinuria, and the use of colloids and diuretics were all independent risk factors for the occurrence of stage 3 AKI in SICH patients. The area under the curve analysis indicated that hypernatremia and hyperuricaemia were predictive factors for stage 3 AKI, and the combination of these two parameters increased their predictability for stage 3 AKI. Kaplan-Meier survival curves revealed that the renal recovery rate in SICH patients with stages 1 and 2 AKI was significantly higher than that in SICH patients with stage 3 AKI. Multivariate Cox regression analysis suggested that hypernatremia and the occurrence of stage 3 AKI are predictors for poor short-term renal recovery.ConclusionsThese findings illustrate that hypernatremia and hyperuricaemia represent potential risk factors for the occurrence of stage 3 AKI in SICH patients. Those patients with hypernatremia and stage 3 AKI were associated with a poor short-term prognosis in renal recovery.
Highlights
Acute kidney injury (AKI) is a known risk factor for adverse clinical outcomes in patients with spontaneous intracerebral haemorrhage (SICH), little is known about the predisposing factors that contribute to renal failure and short-term prognosis in the setting of SICH already complicated by acute kidney injury (AKI)
While AKI has been reportedly associated with increased mortality following acute ischaemic stroke (AIS) [2,3,4,5] and SICH [1, 6], SICH patients are at risk of AKI complicated by hypertension, diabetes mellitus and atherosclerosis
The definition and staging of AKI were based on the serum creatinine (Scr) criteria according to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines in 2012 [10]
Summary
Acute kidney injury (AKI) is a known risk factor for adverse clinical outcomes in patients with spontaneous intracerebral haemorrhage (SICH), little is known about the predisposing factors that contribute to renal failure and short-term prognosis in the setting of SICH already complicated by AKI. In spite of these facts, the association between AKI and SICH remains poorly explored as very few studies have addressed this [2, 5,6,7,8] Most of these previous studies have utilized 3 strata of severity (risk, injury and failure) based on the magnitude of increase in serum creatinine level and/or the duration of oliguria,as well as 2 outcome stages (loss of kidney function and end-stage kidney disease) or different standards of classifications for defining AKI [9]. The authors found that reduced estimated glomerular filtration rate at admission and infections represent potential risk factors for the occurrence of AKI in SICH patients Those patients with AKI were associated with poor neurological outcome and higher mortality,which increased with the severity of AKI [1]. We conducted this retrospective study aimed at identifying both risk factors for the occurrence of stage 3 AKI in patients with SICH and prognostic factors for shortterm renal recovery from AKI using the new KDIGO guidelines
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